ABSTRACT
ABSTRACT: Differentiated thyroid carcinoma (DTC) has been increasing in incidence in the United States over the last several decades, although mortality rates have remained low. Radioactive iodine therapy (RAI-T) has been a mainstay of treatment for DTC since the 1940s. Imaging of DTC before and after RAI-T primarily focuses on molecular imaging of the sodium iodide symporter. The expanding understanding of the molecular profile of DTC has increased available treatment options. Incorporation of risk stratification to treatment approaches has led to deintensification of both surgical and nonsurgical treatments, leading to decreased morbidity without compromising disease control.
Subject(s)
Iodine Radioisotopes , Molecular Imaging , Thyroid Neoplasms , Humans , Thyroid Neoplasms/therapy , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/pathology , Thyroid Neoplasms/diagnostic imaging , Molecular Imaging/methods , Iodine Radioisotopes/therapeutic use , Adult , Symporters/genetics , Symporters/metabolismABSTRACT
RATIONALE AND OBJECTIVES: The aim of this study was to explore the reliability of osteopenia diagnosis based on digital radiographs of appendicular skeleton obtained as part of routine clinical practice as compared with dual-energy x-ray absorptiometry (DEXA) gold standard (Z-score <-1). MATERIALS AND METHODS: The study was an institutional review board-approved retrospective study of 58 children (mean age 12 years [4-18]). Digital radiographs of appendicular skeleton obtained within 6 months of DEXA scanning were presented in a blinded fashion to two musculoskeletal radiologists who were instructed to grade the level of mineralization. Sensitivity and specificity of each reviewer's osteopenia grading were calculated in comparison to lumbar DEXA Z-score values. Interobserver agreement was also calculated and significance evaluated with Bowker's test. RESULTS: The reviewers correctly identified 28% of all patients with severe osteopenia (Z-score ≤-2.0) as well as 26% of all patients with mild osteopenia (-2< Z-score <-1). Interobserver agreement for the correct diagnosis of bone mineral density (BMD) category ranged from 71% for normal BMD (Z-score >-1) to 0 and 25% for mild and severe osteopenia respectively. CONCLUSIONS: Visual diagnosis of osteopenia based on digital radiographs of appendicular skeleton has poor sensitivity and interobserver agreement. Clinical features and risk factors of pediatric patients should therefore guide DEXA evaluation and treatment recommendations.
