Thyroid lesions visualized on CT: sonographic and pathologic correlation.

RATIONALE AND OBJECTIVES: There are no definitive guidelines for the management of incidental thyroid lesions on computed tomography (CT). The objectives of our study were to assess the association between CT and ultrasound (US) characteristics of thyroid lesions and identify CT predictors of benignity or malignancy. MATERIALS AND METHODS: Two hundred fifty-nine patients who had undergone both CT of the chest or neck and thyroid US had at least one thyroid lesion visible on CT; both incidentally detected and palpable or symptomatic lesions were included. The CT and US examinations were retrospectively reviewed and lesions characterized. Pathologic results from fine-needle aspiration (FNA) and surgical excision were used to classify lesions as benign or malignant. Thyroid lesions without pathologic correlation were classified as either benign or indeterminate based on US evaluation. Lesions that were cystic, predominantly cystic, solid and cystic with features consistent with a colloid nodule, or stable for at least 1 year were considered benign. Fisher exact tests, Spearman correlations, and logistic regression models were used to evaluate the associations between CT and US characteristics and CT predictors of benignity or malignancy. Multivariable logistic regression analyses were performed to examine the joint associations between the CT features and sonographically assessed benignity. RESULTS: Of 259 patients, 168 (64.9%) patients had incidentally detected thyroid lesions, 49 (18.9%) patients had palpable/symptomatic lesions, and 116 (44.8%) patients underwent surgical resection and/or FNA biopsy. The malignancy prevalence was 1.8% (3 of 168) for incidental thyroid lesions and 10.2% (5 of 49) for palpable/symptomatic lesions. The malignancy prevalence of incidental lesions initially detected on CT was 1.6% (2 of 125). Of the 143 patients without pathologic data, 58 (40.6%) were classified as benign and 85 (59.4%) were categorized as indeterminate based on US evaluation. Statistically significant associations were found between CT and US with regard to lesion number, dominant lesion size, lesion consistency/composition, and associated calcifications. No CT characteristics of thyroid lesions predicted malignancy. However, there were statistically significant associations on multivariate analysis between indeterminate/benign nodules and CT characteristics of smaller lesion size, lower mean attenuation, and homogeneous composition. CONCLUSIONS: Recommending sonographic evaluation of all incidentally detected thyroid lesions is likely not the appropriate strategy, given the high prevalence of thyroid incidentalomas, low probability of malignancy, and cost effectiveness of workup. Small, homogeneous, low-attenuation lesions have a high probability of being benign.

Concurrent intracranial and spinal subdural hematoma in a teenage athlete: a case report of this rare entity.

A 15-year-old male high school football player presented with episodes of headache and complete body stiffness, especially in the arms, lower back, and thighs, immediately following a football game. This was accompanied by severe nausea and vomiting for several days. Viral meningitis was suspected by the primary clinician, and treatment with corticosteroids was initiated. Over the next several weeks, there was gradual symptom improvement and the patient returned to his baseline clinical status. The patient experienced a severe recurrence of the previous myriad of symptoms following a subsequent football game, without an obvious isolated traumatic episode. In addition, he experienced a new left sided headache, fatigue, and difficulty ambulating. He was admitted and an extensive workup was performed. CT and MRI of the head revealed concurrent intracranial and spinal subdural hematomas (SDH). Clinical workup did not reveal any evidence of coagulopathy or predisposing vascular lesions. Spinal SDH is an uncommon condition whose concurrence with intracranial SDH is an even greater clinical rarity. We suggest that our case represents an acute on chronic intracranial SDH with rebleeding, membrane rupture, and symptomatic redistribution of hematoma to the spinal subdural space.

Multimodal magnetic resonance imaging evaluation of primary brain tumors.

Gliomas comprise 80% of primary brain neoplasms, with glioblastoma multiforme being the most commonly diagnosed glioma. The annual incidence is 5.26 per 100,000, or 17,000 newly diagnosed cases per year in the United States. The incidence increases with age, peaking between the 6th and 8th decades. Gliomas are more common among Caucasians and occur more often in men. They can be associated with certain rare hereditary syndromes including Cowden, Turcot, Li-Fraumeni, neurofibromatosis type 1 and type 2, tuberous sclerosis, and familial schwannomatosis. Known risk factors include a history of ionizing radiation, family history of glioma, and certain genetic susceptibility variants that are weakly associated with glioma. Preventative measures have not been shown to decrease the risk of later development. In addition, screening tests are unwarranted since early diagnosis and treatment have not been shown to improve outcome.