US Features Research Articles

Thyroid Nodule with Benign Cytology: Is Clinical Follow-Up Enough?

ObjectiveIn this multicenter study, we investigated the management algorithm for thyroid nodules with benign cytology using US features from data collected from 7 institutions.Materials and MethodsThe institutional review board approved this retrospective study. Data on 700 focal thyroid nodules in 673 consecutive patients were collected from 7 university-affiliated hospitals. This study included nodules that were diagnosed as benign at initial cytologic evaluation and that underwent pathologic or follow-up study. The risk of malignancy was compared according to the US assessments of each institution as well as looking at all the nodules together as a whole.ResultsOf the 700 nodules, 688 (98.3%) were benign and 12 (1.7%) were malignant. If initial cytologic results were benign, the likelihood of the nodule actually being malignant was from 1 to 3%, varying by institution. The likelihood of a cytologically benign nodule with positive US being malignant (4.7%, 8/169) was higher than that of one without positive US (0.8%, 4/531) (P = .002).ConclusionBased on our multicenter study, repeat FNA should be performed in thyroid nodules with initial benign cytology showing suspicious US features in order to decrease the number of false negative cases.

Paths to Carbon Stabilization: How Foreign Carbon-Restricting Reforms Will Affect US Industry, Climate Policy and the Prospects of a Binding Climate Change Treaty

This article investigates new paths for achieving a binding treaty on emission stabilization. Because industry support for US participation in such an agreement is essential, an empirical analysis of lobbying expenditures during Congress’s last attempt to pass emission-restricting legislation is used to gauge industry support and opposition for such reform. The article qualifies its finding of no major spending asymmetry and explains the role of ideological and structural features of the US political system in impeding the passage of any such bill. Scepticism aside, it argues that a shift in US climate policy is coming due to: (i) the implementation of foreign carbon-restricting regimes; and (ii) the US exporters’ response to these reforms. A microeconomic analysis demonstrates that US exporters will increasingly elect carbon-efficient technologies to minimize costs and adjust to a changing regulatory environment. This shift in the carbon intensity of production will cause these industries to form a majority coalition with pro-environment groups in favour of domestic and global emission-restricting reforms. Because these developments lead to the use of border measures designed to curb carbon leakage and address trade concerns, the article makes a few suggestions for reducing potential conflicts between the trade and climate change regimes.

Role of combined grey scale US and US tissue elastography in differentiating solid thyroid nodules

BackgroundUltrasonographic (US) examination is an accurate method for detecting thyroid nodules, but its use in differentiating between benign and malignant thyroid nodules is relatively low. US elastography has been applied to study the hardness/elasticity of nodules to differentiate malignant from benign lesions thus deviating a significant group of patients from unnecessary FNAB. ObjectivesThe aim of the study is to evaluate the validity of combined grey scale US and tissue elastography in differentiating benign form malignant solid thyroid nodules. MethodsThe study included 46 selected patients with solid thyroid nodules according to our inclusion and exclusion criteria. The patients underwent surgery for compressive symptoms or suspicion of malignancy on FNA cytology. US features and tissue elastography were scored according to the Rago criteria (1). ResultsOn US elastography: all the 31 cases with a final diagnosis of benign nodule had a score of 1–3, while 14 of 15 (94.1%) with a final diagnosis of carcinoma had a score of 4–5, with a sensitivity of 93.3%, a specificity of 100% and an accuracy of 97.8%. Combined US and elastography reveals that hypoechogenicity/score 4–5 was most predictive of malignancy with sensitivity 80% and specificity 100%; and accuracy 93.4%. ConclusionsUS elastography seems to have great potential as a new tool for differentiating solid thyroid nodules and for recommending FNAC. Combined grey scale US features and US elastography added no significant value when compared with US elastography alone. Further prospective studies are needed.

Computer-Assisted Analysis of Ultrasonographic Features of Calcified Thyroid Nodules

Brief Description of the Purpose of the Studyto determine computerized US features of calcified thyroid nodules that are useful in the differentiation between malignant and benign lesions.MethodsDigital US images of 99 pathologically-proven thyroid nodules with calcifications (malignant: benign = 78: 21) were evaluated. We designed and implemented a CAA scheme to quantitatively analyze the 24 US features of the calcified thyroid nodules based in two categories: morphology and calcification. We performed Student’s t-test and discriminant analysis and generated receiver operating characteristic (ROC) curves and the corresponding areas under the curve (AUC) in order to compare morphology, calcification and combined features.Main ResultsAmong the 24 analyzed features, 10/12 (83.3%) morphology and 7/12 (58.3%) calcification features showed significant differences between malignant and benign thyroid nodules (p < 0.05). The AUC values for morphology, calcification and combined features were 0.81 (95% CI, 0.75-0.86), 0.79 (95% CI, 0.73-0.84), and 0.86 (95% CI, 0.81-0.91), respectively. The combined features showed a significantly higher AUC value than morphology or calcification features alone (p < 0.05).Importance of the ConclusionsCombined morphology and calcification features from CAA had a significantly higher diagnostic performance in differentiating malignant from benign calcified thyroid nodules when compared to the use of morphology or calcification features alone. Brief Description of the Purpose of the Studyto determine computerized US features of calcified thyroid nodules that are useful in the differentiation between malignant and benign lesions. to determine computerized US features of calcified thyroid nodules that are useful in the differentiation between malignant and benign lesions. MethodsDigital US images of 99 pathologically-proven thyroid nodules with calcifications (malignant: benign = 78: 21) were evaluated. We designed and implemented a CAA scheme to quantitatively analyze the 24 US features of the calcified thyroid nodules based in two categories: morphology and calcification. We performed Student’s t-test and discriminant analysis and generated receiver operating characteristic (ROC) curves and the corresponding areas under the curve (AUC) in order to compare morphology, calcification and combined features. Digital US images of 99 pathologically-proven thyroid nodules with calcifications (malignant: benign = 78: 21) were evaluated. We designed and implemented a CAA scheme to quantitatively analyze the 24 US features of the calcified thyroid nodules based in two categories: morphology and calcification. We performed Student’s t-test and discriminant analysis and generated receiver operating characteristic (ROC) curves and the corresponding areas under the curve (AUC) in order to compare morphology, calcification and combined features. Main ResultsAmong the 24 analyzed features, 10/12 (83.3%) morphology and 7/12 (58.3%) calcification features showed significant differences between malignant and benign thyroid nodules (p < 0.05). The AUC values for morphology, calcification and combined features were 0.81 (95% CI, 0.75-0.86), 0.79 (95% CI, 0.73-0.84), and 0.86 (95% CI, 0.81-0.91), respectively. The combined features showed a significantly higher AUC value than morphology or calcification features alone (p < 0.05). Among the 24 analyzed features, 10/12 (83.3%) morphology and 7/12 (58.3%) calcification features showed significant differences between malignant and benign thyroid nodules (p < 0.05). The AUC values for morphology, calcification and combined features were 0.81 (95% CI, 0.75-0.86), 0.79 (95% CI, 0.73-0.84), and 0.86 (95% CI, 0.81-0.91), respectively. The combined features showed a significantly higher AUC value than morphology or calcification features alone (p < 0.05). Importance of the ConclusionsCombined morphology and calcification features from CAA had a significantly higher diagnostic performance in differentiating malignant from benign calcified thyroid nodules when compared to the use of morphology or calcification features alone. Combined morphology and calcification features from CAA had a significantly higher diagnostic performance in differentiating malignant from benign calcified thyroid nodules when compared to the use of morphology or calcification features alone.

Imaging Findings of Solitary Cysticercosis in the Intermuscular Area of the Thigh

Cysticercosis is a disease caused by encysted larvae of the tapeworm Taenia solium. The purpose of this case is to characterize the US and MR imaging features of solitary intermuscuar cysticercosis involving the thigh and to correlate the imaging features with pathologic findings. A patient, female, 54-years old, was hospitalized to treat a mass in the right thigh without trauma history. The overlaying skin was normal. Ultrasonography showed a cystic mass of 2.8 cm in size located in the intermuscular area of the medial aspect of the right thigh. Lesion contained tubular, folded, worm-like structure, which is suggestive of scolex. MRI findings revealed high signal intensity mass on T2-weighted image, showing hypointense on T1-weighted image and irregular thin peripheral enhancement in the medial aspect of the right thigh between gracilis and adductor muscle groups. Sagittal T2-weighted image demonstrated a tubular, hypointense structure located within the lesion corresponding to the worm-like structure seen on ultrasound. Cysticercosis should be kept as a differential diagnosis for any case of focal myositis or subcutaneous swellings. Although it is difficult to diagnose solitary soft tissue cysticercosis, if characteristic scolex can be demonstrated with any imaging modality, the diagnosis of cysticercosis can be easier.

Is Follow-up BRAFV600E Mutation Analysis Helpful in the Differential Diagnosis of Thyroid Nodules with Negative Results on Initial Analysis?

BackgroundWe evaluated the usefulness of follow-up BRAFV600E mutation analysis using ultrasonography-guided fine-needle aspiration (US-FNA) in diagnosis of thyroid nodules showing negative BRAFV600E mutation on prior analysis.Methodology/Principal FindingA total of 49 patients (men: 6, women: 43, mean age: 50.4 years) with 49 thyroid nodules were included. Patients had undergone initial and follow-up US-FNA and subsequent BRAFV600E mutation analysis from US-FNA aspirates. All patients had negative results on initial BRAFV600E mutation analysis. Clinicopathologic findings, US assessment, and BRAFV600E mutation results were analyzed according to the final pathology. Of the 49 nodules, 12 (24.5%) were malignant and 37 (75.5%) were benign. Seven (58.3%) of the 12 malignant nodules were positive for BRAFV600E mutation on follow-up, all showing suspicious US features. Initial US-FNA cytology of the 7 nodules were non-diagnostic (n = 2), benign (n = 2), or atypia (n = 3), while follow-up were benign (n = 1), indeterminate (n = 1), suspicious for malignancy (n = 4), and malignancy (n = 1).Conclusions/SignificanceFollow-up BRAFV600E mutation analysis may be helpful in the diagnosis of selected thyroid nodules negative for BRAFV600E mutation on initial analysis, which are assessed as suspicious malignant on US, diagnosed as non-diagnostic, benign or atypia on follow-up US-FNA.

Radiologic findings of epiploic appendagitis

The aim of this case report is to present typical US and CT features of epiploic appendagitis, characterized by the ischemia and inflammation of the epiploic appendices of the colon. A 44 year old man was admitted with a localized pain to umblical region. Physical examination revealed rebound tenderness. US examination showed a hyperechoic mass with a hypoechoic rim posterior to abdominal wall and CT features confirmed the diagnosis of epiploic appendagitis. The case was managed conservatively and had a self limited course.

Regime switches in the Sino-American co-dependency: Growth and structural change in China

We present a two-country two-stage growth model capturing several salient features of the special US–China relationship and reproducing the process of export-led growth and structural change in China. In phase 1, China accumulates and sterilizes US assets (and finances US consumption) as it pegs the renminbi to the dollar at an undervalued level, thus stimulating the domestic production of tradables, compressing domestic consumption and facilitating the transition of surplus labor into the modern sectors of the economy. In phase 2, we analyze possible future scenarios. In Scenario A, the Chinese fiscal policy is effective in partially substituting exports by shifting the domestic demand toward tradables. Scenario B emphasizes the risks for China of abandoning too early the pegging. Scenario C shows that the Chinese continuation of an export-led growth strategy is economically feasible.

Reducing the Time in Making the Diagnosis and Improving Workflow With Point-of-Care Ultrasound

During the past decade, point-of-care ultrasound (POC US) has been increasingly performed in emergency medicine for a variety of indications. However, pediatric emergency physicians have been slower to understand the importance of POC US in the diagnosis of critical care cases. This study aimed to illustrate the usefulness of POC US in improving workflow in the emergency department (ED) with an early diagnosis in a critically ill child by a pediatric emergency attending physician. On arrival to the ED, an early diagnosis of intussusception was made using real-time POC US by a pediatric emergency medicine attending physician well trained in pediatric US. This report illustrates the impact that POC US can make during an early diagnosis of intussusception. With thorough knowledge of the US features characteristic of intussusception, its accurate diagnosis using POC US has the potential to reduce morbidity and mortality as well as improve patient flow and throughput time in the ED.

Imaging features of benign adenomyoepithelioma of the breast

The purpose of our study was to evaluate the imaging features of benign adenomyoepithelioma of the breast with a focus on sonographic (US) appearances. Ten benign adenomyoepitheliomas in 9 patients were included in this study. Mammographic and US findings were analyzed retrospectively by 2 radiologists according to the Breast Imaging-Reporting and Data System (BI-RADS) lexicon. The BI-RADS final assessment category was also recorded. Of the 8 lesions for which mammography was available, 4 lesions presented with abnormal findings. Two lesions presented with an indistinct, irregular, isodense mass and a circumscribed, oval, isodense mass. The other 2 lesions presented with areas of focal asymmetry and asymmetry, respectively. On US, all of 10 lesions presented as a mass. The masses measured 0.5-1.2 cm (mean, 0.8 cm), were irregular (n = 8) or oval (n = 2) with microlobulated (n = 5), indistinct (n = 3), or angular (n = 2) margins. They were all hypoechoic, had non parallel orientation in 6 cases, and increased peripheral vascularity in 7 cases. The BI-RADS final assessment category was 4B in 6, and 4A in 4. Mammographic findings of benign adenomyoepithelioma were nonspecific. An irregular, non parallel orientation, microlobulated or indistinct margin, hypoechogenicity, and increased peripheral vascularity were the most frequent US features.

East‐west differences inF‐region electron density at midlatitude: Evidence from the Far East region

The global configuration of the geomagnetic field shows that the maximum east‐west difference in geomagnetic declination of northern middle latitude lies in the US region (~32°), which produces the significant ionospheric east‐west coast difference in terms of total electron content first revealed by Zhang et al. (2011). For verification, it is valuable to investigate this feature over the Far East area, which also shows significant geomagnetic declination east‐west gradient but smaller (~15°) than that of the US. The current study provides evidence of the longitudinal change supporting the thermospheric zonal wind mechanism by examining the climatology of peak electron density (NmF2), electron density (Ne) of different altitudes in the Far East regions with a longitude separation of up to 40–60° based on ground ionosonde and space‐based measurements. Although the east‐west difference (Rew) over the Far East area displays a clear diurnal variation similar to the US feature, that is negativeRew(West Ne &gt; East Ne) in the noon and positive at evening‐night, the observational results reveal more differences including: (1) The noontime negativeRewis most pronounced in April–June while in the US during February–March. Thus, for the late spring and summer period negativeRewover the Far East region is more significant than that of the US. (2) The positiveRewat night is much less evident than in the US, especially without winter enhancement. (3) The magnitude of negativeRewtends to enhance toward solar maximum while in the US showing anticorrelation with the solar activity. The altitude distribution of pronounced negative difference (300–400 km) moves upward as the solar flux increases and hence produces the different solar activity dependence at different altitude. The result in the paper is not simply a comparison corresponding to the US results but raises some new features that are worth further studying and improve our current understanding of ionospheric longitude difference at midlatitude.

Scale depending variations of distribution and dynamic features of US Dollar/Georgian Lari exchange rate

Scale depending variations of distribution and dynamic features of US Dollar/Georgian Lari exchange rate

The use of ultrasound in the assessment of the glenoid labrum of the glenohumeral joint. Part II: Examples of labral pathologies.

Labral pathologies of the glenohumeral joint are most commonly caused by trauma. The majority of lesions affect the anterior part of labrum, resulting from much higher frequency of anterior shoulder dislocations over posterior ones. Another subgroup of labral lesions, not directly related to joint instability, are SLAP tears. Other findings include degenerative changes of labrum and paralabral cysts. Diagnostic imaging is crucial for making a decision regarding operative treatment. Apart from a standard X-ray examination, the imaging mainly relies on magnetic resonance or computed tomography arthrography. Based on their own experience, the authors propose the use of ultrasound in the assessment of labral tears of the glenohumeral joint. Different signs indicating labral pathology may be discovered and assessed during ultrasound examination. They include permanent displacement of the labrum onto the glenoid, labral instability during dynamic examination, lack of the labrum in the anatomical position, hypoechoic zone at the base of the labrum >2 mm in width, residual or swollen labrum as well as paralabral cyst(s). The most frequent appearance of labral pathology is displacement of the anteroinferior labrum onto the external aspect of the glenoid typically seen after anterior shoulder dislocation. The another most important US feature is labral instability while dynamically examined. The swelling or reduced size of the labrum usually indicates degeneration. This article presents sonographic images of selected labral pathologies.

Is US-guided Core Needle Biopsy (CNB) enough in Probably Benign Nodules with Interval Growth?

To investigate whether ultrasound-guided 14-gauge core needle biopsy (US-CNB) is efficient in the diagnosis of probably benign lesions showing interval growth on follow-up US. From March 2008 to August 2009, 116 breast lesions in 113 women (mean age: 41.2 years, range: 19 - 63 years) which were initially assessed as category 3 showing interval growth on follow-up US underwent US-CNB, and subsequent US-guided vacuum-assisted excision, surgical excision or follow-up US for at least 12 months. Diagnostic performances of US-CNB were evaluated with histopathologic results and follow-up US as standard reference. Clinical features of the patient and lesions characteristics including follow-up interval (I), the most increased diameter (D), D per I, increased volume (%V) and %V per I were calculated and compared. Of the 116 lesions, 4 lesions were diagnosed as malignancy and 112 as benign on final pathology. Malignancy rate of probably benign lesions showing interval growth was 3.4 % (4/116). Incorrect biopsy rate was 0.9 % (1/116). Palpability or newly developed suspicious US features were more associated with malignancy, 75.0 to 13.4 % and 50.0 to 25.9 %, respectively, but without significance (p = 0.063 and 0.290). Significant differences were seen in average rank when comparing between benign and malignancy in D, %V, D per follow-up interval (I), and %V/I (p = 0.037, 0.017, 0.043 and 0.009, respectively). US-CNB is an efficient diagnostic method for probably benign lesions showing interval growth, with discordant biopsy rate of 0.9 %.

US‐FNA and CNB in Cervical Lymphadenopathy Diagnosis

Objective: We aimed to characterize sonographic findings of various malignant cervical lymphdenopathy (MCL) and to compare the effectiveness between ultrasound-guided fine-needle aspiration(US-FNA) and core-needle biopsy (US-CNB) in achieving their diagnosis. Method: A total of 113 MCL patients, receiving real-time US-FNA or US-CNB, were rectrospectively reviewed from July 2007 to Dec 2011. Results of FNA cytology and CNB pathology were categorized as being false negative, suspicous, and positive for malignancy. The US features, time from needle biopsy to diagnosis were also recorded and compared statistically. Results: The US-FNA with false-negative rate 50% (7/14) for lymphomatous nodes (LYM) was significantly higher than those of nonthyroid primary carcinoma (META; 0%; 0/60), papillary thyroid carcinoma (PAP; 8.3%;1/12), and US-CNB for LYM (0%; 0/13) and META (0%;0/14). Comparing time from needle procedure to diagnosis among META-FNA, LYM-FNA, PAP-FNA, META-CNB, and LYM-CNB, US-FNA had the longest time to diagnosis ( P &lt; .01, Log-rank test). Discriminating US indicators included internal echo, S-axis/L-axis ratio, hilar echogenicity, calcification, and cystic formation. Conclusion: Sonographic finding are valuable for MCL diagnosis and in deciding whether US-FNA or US-CNB should be done. US-FNA can be a diagnostic tool for most MCL. US-CNB, however, should be performed if malignant lymphoma is suspected.

Features of the US Direct Election System of the Educational Superintendent and Its Implications for the South Korean System

Features of the US Direct Election System of the Educational Superintendent and Its Implications for the South Korean System

Sonographic features of histopathologically benign solid breast lesions that have been classified as BI‐RADS 4 on sonography

To describe the sonographic (US) features associated with ultrasonography BI-RADS category 4 lesions that have a benign histopathological outcome. One hundred seventy-two histopathologically proven benign lesions in 169 patients, which had been classified as BI-RADS category 4 with ultrasonography, were retrospectively evaluated. Ultrasonography and histopathology findings were analyzed. The frequency of sonographic findings according to the histopathological diagnosis was determined. Among the 172 lesions, there were 66 (38%) fibroadenomas, 31 (18%) sclerosing adenoses, 24 (14%) fibrocystic changes, 16 (9%) mastitis/inflammations, 9 (5.5%) intraductal papillomas, 8 (5%) focal fibroses, 4 (2.5%) atypical ductal hyperplasias, 4 (2.5%) fat necroses, 2 (1%) phyllodes tumors, 1 (0.5%) tubular adenomas, 1 (0.5%) epidermal inclusion cysts, and 6 (3.5%) "other benign lesions." The most frequent sonographic findings were heterogeneity, indistinct margin, microlobulation in fibroadenomas; heterogeneity, irregular-indefinite margin, and antiparallel orientation in sclerosing adenosis; heterogeneity, microlobulation, and acoustic shadowing in fibrocystic changes. BI-RADS category 4 lesions demonstrate more than one suspicious ultrasonography feature, and biopsy is necessary to diagnose malignancy captured in 33% of lesions in this study. At this time, any lesion with more than one suspicious BI-RADS US feature cannot avoid a diagnostic biopsy.

Hybrids in Hollywood: a study of the production and performance of genre-spanning films

Research suggests there are significant market penalties for organizations that do not conform to category boundaries in their product offerings. Yet, organizations continue to span categories despite these risks. In this study, we shed insight into why by examining factors that shape the attractiveness of producing hybrid (i.e. category-spanning) products. In particular, we argue that more ambiguous category schemas encourage hybridization. Moreover, there is potential for exceptional performance advantages for organizations that innovate through hybrids. We use data from the US feature film industry to test and find support for our hypotheses. Copyright 2012 The Author 2012. Published by Oxford University Press on behalf of Associazione ICC. All rights reserved., Oxford University Press.

Decreasing morbidity and improving workflow with point‐of‐care ultrasound in the Emergency Department

Point‐of‐Care Ultrasound (POC US) has been increasingly performed in emergency medicine for a variety of indications. However, pediatric emergency physicians have been slower to understand the importance of POC US in the diagnosis of critical care cases.Here I report a case of a two year‐old male that presented to the emergency department (ED) with vomiting and abdominal pain. On arrival to the ED, an immediate diagnosis of intussusception was made using real‐time POC US by a pediatric emergency attending well trained in pediatric US. This illustrates the impact that POC US can make with an early diagnosis of intussusception. This diagnosis is best made by an experienced sonographer, such as the radiologist. However, in some pediatric hospitals, radiology department US may not be readily available. The intussusception mass is a large structure and characteristically does not contain any bowel gas, which makes it readily identifiable with US. Studies have shown that extensive training and experience is not necessary for high accuracy in diagnosing intussusception.With thorough knowledge of the US features characteristic of intussusception, its accurate diagnosis using POC US has the potential to reduce morbidity and mortality as well as improve patient flow, work flow and throughput time in the ED. Training of pediatric emergency physicians in POC US is highly advised.

Prospective evaluation of multiparametric ultrasound and quantitative elastosonography in the differential diagnosis of benign and malignant thyroid nodules: Preliminary experience

PurposeTo assess the clinical value of quantitative elastosonography compared with multiparametric ultrasound in differentiating the nature of thyroid nodules. Methods and materialsNinety-seven consecutive patients (32 males, 65 females, mean age, 54 years, range 20–81 years) with thyroid nodules previously detected at color-Doppler ultrasound (CDUS), were prospectively examined with elastosonography with dedicated quantitative software (Elasto-Q, Toshiba) before surgery. Ultrasound examination and elastosonography were evaluated by two investigators in consensus. US features, color-Doppler pattern, and strain ratio value were evaluated. Sensitivity and specificity of CDUS and sono-elastography were compared using X2 test and ROC curves. ResultsSensitivity and specificity of hypoechogenicity, irregular margins or suspicious halo features, CDUS blood flow pattern, and strain ratio in the diagnosis of malignant nodules were 56.8%, 62.2%, 54.1% and 97.3% and 71.7%, 93.3%, 28.3%, and 91.7%, respectively. Elastosonography was more sensitive and specific than all ultrasonographic features in predicting malignancy of the thyroid nodules (p<0.0001). According to elastosonographic features the lesions characterized by strain ratio ≥2 were highly likely to be of malignant nature (p<0.0001, O.R. 396, 95%, CI: 44–3530). ConclusionsThe results of the present study suggest that elastosonography with Q system is a valuable tool in the characterization of thyroid nodules and it seems to be far more accurate than CDUS. These findings as well as those of previous studies support its use in selecting patients who are candidates for surgery.