Role of apparent diffusion coefficient values and diffusion-weighted magnetic resonance imaging in differentiation between benign and malignant thyroid nodules.

OBJECTIVE: The purpose of the study was to differentiate between benign and malignant thyroid nodules using nodule-spinal cord signal intensity and nodule apparent diffusion coefficient (ADC) ratios on diffusion-weighted magnetic resonance imaging (DW-MRI). MATERIALS AND METHODS: Forty-four patients (27 females, 17 males; mean age, 49 years) with nodules who underwent DW-MRI were included in this study. The images were acquired with 0, 50, 400 and 1000 s/mm(2)b values. ADC maps were calculated afterwards. Fine needle aspiration biopsies (FNAB) were performed at the same day with DW-MRI acquisition. The diagnosis in patients where malignity was detected after FNAB was confirmed by histopathologic analysis of the operation material. The signal intensities of the spinal cord and the nodule were measured additionally, over b-1000 diffusion-weighted images. Nodule/cord signal intensity (SI) ratios were obtained and the digital values were calculated by dividing to ADC values estimated for each nodule. Statistical analysis was performed. RESULTS: The (nodule SI-cord SI)/nodule ADC ratio is calculated in the DW images, and a statistically significant relationship was found between this ratio and the histopathology of the nodules (P<.001). The ratio was determined as 0.27 in benign and 0.86 in malignant lesions. The result of receiver operating characteristic (ROC) analysis was statistically significant, and the area under curve (100%) was considerably high. The threshold value was calculated as 0.56 according to the ROC analysis. According to this threshold value, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates for (nodule SI/cord SI)/ADC ratios in differentiating benign from malignant thyroid nodules are calculated as 100%, 97%, 83%, 100%, and 98%, respectively. CONCLUSION: We have found that (nodule/cord SI)/nodule ADC ratio has the highest values for sensitivity and specificity among the tests defined for characterization of nodules.

Plasma ghrelin levels in males with idiopathic hypogonadotropic hypogonadism.

It has recently been shown that ghrelin is a pleitropic modulator with effects on diverse biological functions, such as energy homeostasis and reproduction. In this study, ghrelin levels and its relationship between metabolic and biochemical parameters were investigated in male subjects with idiopathic hypogonadotropic hypogonadism (IHH). Patients in the study were composed of 33 men with IHH, and controls were composed of 36 healthy age-matched men. The patients' group had significantly higher waist/hip ratio (WHR), and lower testis volume, luteinizing hormone (LH), follicle stimuling hormone (FSH) and total testosterone (TT) levels when compared with controls. Plasma total ghrelin levels were significantly lower in patients than in controls (96.4 +/- 29.1 ng/ml vs. 146.1 +/- 28.9 ng/ml, P < 0.001, respectively). No correlation of ghrelin was found with body mass index, waist/hip ratio, homeostasis model assessment insulin resistance index, testis volume, LH, FSH and TT levels in both patients and controls. The present study showed that ghrelin levels were significantly lower in men with IHH than in controls. However, further studies are needed to better understand the relationships between ghrelin, and metabolic and reproductive systems.

Comparison of ultrasonographic and laparoscopic findings in adult nonpalpable testes cases.

OBJECTIVE: There is a small number of studies in adult nonpalpable testes cases, and there is no published paper on the diagnostic value of their ultrasonographic examination. In this prospective study, we compared the sonographic and laparoscopic findings in adult cases with nonpalpable testes to assess the necessity and the profits of ultrasound. MATERIALS AND METHODS: 50 cases, 38 unilateral and 12 bilateral, with nonpalpable testes were investigated. Patients' ages ranged from 20 to 25 years with a mean of 22. Sonographic examinations were performed with a high-resolution ultrasonography device. RESULTS: Laparoscopic evaluation of the patients with unilateral nonpalpable testis yielded 27 testes out of a total 38. In one case, the testis was detected in the inguinal canal with inguinal exploration. The remaining 10 cases were regarded as vanishing testes. All 24 testes of 12 patients with bilateral nonpalpable testes were found. The pre-laparoscopic ultrasonographic examination detected 20 of 24 testes in bilateral cases (83% sensitivity), and 17 of 26 testes in unilateral cases (65% sensitivity). CONCLUSION: Our results suggest that ultrasonography does not exclude the necessity for laparoscopy, and it is not superior to physical examination in detection of the inguinal atrophic testes or testicular nubbin.

Sacroiliac joint injections performed with sonographic guidance.

OBJECTIVE: To investigate the feasibility and effectiveness of sonographic guidance for therapeutic intra-articular sacroiliac joint injections in patients with sacroiliitis. METHODS: Thirty-four consecutive patients with sacroiliitis were enrolled in this study. The synovial portions of 60 sacroiliac joints received injections under sonographic guidance. For treatment, a mixture of a corticosteroid and a local anesthetic was injected intra-articularly. Fluoroscopic spot images were obtained to assess the accuracy of the sonographically guided technique. RESULTS: Of the 60 sonographically guided injections, 46 (76.7%) were successful (i.e., intra-articular), and 14 (23.3%) were missed. The successful intra-articular injection rate was 60% in the first 30 injections, and it gradually improved, reaching 93.5% in the last 30 injections. The mean procedure time was 9 minutes. CONCLUSIONS: Our initial experience suggests that sonographically guided therapeutic injections to sacroiliac joints could be valuable alternatives to other guidance modalities in patients with sacroiliitis. In the hands of experienced radiologists, this technique is safe, rapid, and reproducible.