Risk Threshold Algorithm for Thyroid Nodule Management Demonstrates Increased Specificity and Diagnostic Accuracy as Compared With American College of Radiology Thyroid Imaging, Reporting and Data System; Society of Radiologists in Ultrasound; and American Thyroid Association Management Guidelines.

We studied diagnostic performance of an algorithm guiding thyroid nodule management using a malignancy risk model as compared with extant management guidelines. Single-institution, retrospective study was performed with sequential cases from pathology registry from 2012 to 2015. Seventy-eight patients were enrolled, with benign and malignant groups defined by aspiration results. Risk Threshold Algorithm determined management based off of a logistic regression model and a risk threshold. American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS), Society of Radiologists in Ultrasound (SRU), and American Thyroid Association (ATA) guidelines were used in comparison. Sensitivity, specificity, positive/negative predictive values, receiver operating characteristic (ROC) values were derived, with significance assessed via McNemar and permutation tests. Forty-four benign nodules and 40 papillary thyroid carcinomas were included. Risk Threshold Algorithm area under the ROC curve was 0.80 versus 0.59 (ACR TI-RADS), 0.49 (SRU), and 0.44 (ATA); all areas under the ROC curve differences were statistically significant. Risk Threshold Algorithm demonstrates sensitivity, specificity, positive predictive value, and negative predictive values of 63%, 91%, 86%, and 73% at the risk threshold maximizing diagnostic performance, compared with 85%, 39%, 56%, and 74% (ACR TI-RADS); 85%, 18%, 50%, and 57% (SRU); and 89%, 11%, 50%, and 83% (ATA). Sensitivity and specificity were significantly different between all groups except SRU versus TI-RADS. The Risk Threshold Algorithm, based on a malignancy risk model, demonstrates increased overall diagnostic accuracy as compared with ACR TI-RADS, SRU, and ATA management guidelines. Through eliminating unnecessary biopsy, patient anxiety, and morbidity can be reduced.

Computed tomography of acute heart failure: A novel case and literature review.

Computed tomography (CT) is used in patients whose conditions span the gamut from healthy to critically ill. In the specific subset of patients with cardiac arrest or imminent cardiac failure who receive contrast-enhanced CT, extant literature illustrates a set of imaging findings that include inferior vena cava and hepatic parenchymal contrast reflux, pooling, and layering in a dependent fashion. We review the literature and present a case in which these findings are demonstrated along with renal venointerstitial reflux, a finding that has not been previously described.

Splenic trauma: pictorial review of contrast-enhanced CT findings.

Splenic trauma is a common entity of high clinical significance that may have a variety of imaging manifestations. This article reviews splenic anatomy and function, mechanisms of splenic trauma, and the classification and grading of splenic trauma, with a particular focus on contrast-enhanced CT. Heterogeneous early enhancement of the spleen and technical suggestions to minimize this artifact are discussed. Mechanisms of trauma and their classification under the American Association for the Surgery of Trauma are discussed and illustrated. The merits of an alternative classification system by Marmery et al. are also considered. We conclude that knowledge of the mechanisms, classifications, and grades of splenic trauma can assist the clinician in clinical decision making and promote improved patient outcomes.