ABSTRACT
BACKGROUND: Positron emission tomography/computed tomography is suggested to have a role in detection of iodine negative recurrence in well differentiated thyroid cancer. The aim of this study is to identify role of different imaging modalities in the management of well differentiated thyroid cancer. METHODS: We reviewed 900 well differentiated thyroid cancer patients after post-thyroidectomy who underwent recombinant human thyroid stimulating hormone stimulated Sodium Iodide I 131 imaging. Out of 900 patients, 74 had positron emission tomography/computed tomography. Multivariate analysis was performed by controlling positron emission tomography/computed tomography, Sodium Iodide I 131 scan, neck ultrasonography, age, sex, primary tumor size, stage, histology, thyroglobulin. Patients were grouped according to results of Sodium Iodide I 131 scan and positron emission tomography/computed tomography. RESULTS: Positron emission tomography/computed tomography was positive in 23 of 74 patients. The sensitivity for positron emission tomography was 11/11(100%), the specificity was 51/63 (81.0%), the positive predictive value was 11/23 (47.8%), and the negative predictive value was 51/51 (100%). The sensitivity for the neck ultrasonography was 4/8 (50%), the specificity was 53/60 (88.3%), positive predictive value was 4/11 (36.4%), and negative predictive value was 53/57 (93.0%). 50% of patients who had Sodium Iodide I 131 negative scan and positive positron emission tomography/computed tomography had a change in management. Thirty-six percent with positive neck ultrasonography had a change in management. Out of 11 recurrences, 6 had distant metastatic disease, and 5/11 had regional nodal disease. Neck ultrasonography showed nodal metastasis in 4/5 (80%). CONCLUSION: Positron emission tomography/computed tomography altered management in the presence of a high thyroglobulin level and a negative Sodium Iodide I 131 scan. Neck ultrasonography should be the first line of imaging with rising thyroglobulin levels. Positron emission tomography/computed tomography should be considered for cases with high thyroglobulin levels and normal neck ultrasonography to look for distant metastatic disease.
ABSTRACT
We present a case of an immunocompetent patient who developed Aspergillus meningitis, subsequent to discitis, presumed to be from an epidural steroid injection. Magnetic resonance imaging (MRI) of the lumbar spine confirmed the diagnosis of discitis. Fluoroscopic-guided aspiration of the disc showed growth of Aspergillus fumigatus. MRI of the brain revealed involvement of the right third cranial nerve. Repeat MRIs demonstrated multiple leptomeningeal masses consistent with granulomatous meningitis. Meningitis is a rare complication of discitis, discogram, or epidural steroid injection. Aspergillus usually only infects immunocompromised patients, but rarely can affect immunocompetent patients.
Subject(s)
Aspergillosis/diagnosis , Discitis/diagnosis , Immunocompetence , Meningitis, Fungal/diagnosis , Aspergillosis/drug therapy , Aspergillosis/microbiology , Aspergillus fumigatus/immunology , Aspergillus fumigatus/isolation & purification , Brain/pathology , Discitis/drug therapy , Discitis/microbiology , Disease Progression , Fatal Outcome , Female , Humans , Injections, Epidural/adverse effects , Lumbosacral Region/pathology , Magnetic Resonance Imaging/methods , Meningitis, Fungal/drug therapy , Meningitis, Fungal/microbiology , Middle Aged , Obesity, Morbid/complications , Patient Readmission , Pulmonary Disease, Chronic Obstructive/complications , Rare DiseasesABSTRACT
OBJECTIVE: The aim of this study was to show the usefulness of MR cholangiopancreatography (MRCP) in demonstrating biliary system pathologies in patients with a history of vagotomy and Billroth II operations. METHODS: The hepatobiliary system of eight patients with a history of vagotomy and Billroth II operations was evaluated with MRCP. Three-dimensional fast spin-echo technique was used at a 1.0-T scanner with following parameters: TR=2857-4615 ms, TE=850-1117 ms, BW=31.2, FOV=40, 21-28 slices, NEX=0.5, scan time = 90 s. RESULTS: Eight patients were evaluated with MRCP. Three patients had cholecystectomy. In one patient the gall bladder wall was thickened, accompanied with an irregular, unknown filling defect at the level of the fundus. Four of these patients had common bile duct stones. Two patients had gallstones and one patient had a stone in the common hepatic duct. A capping deformity of the distal common bile duct was observed in all of the patients. CONCLUSION: We conclude that MRCP can be used effectively for evaluation of biliary system of patients with previous history of biliary or gastric operations.
