Ethanol ablation of benign thyroid cysts and predominantly cystic thyroid nodules: factors that predict outcome.

No study has so far investigated the relationship between aspirate color or degree of aspiration on the success of ethanol ablation (EA) of cystic thyroid nodules. We aimed to evaluate the efficacy of EA of benign cystic thyroid nodules and assess the relevant factors influencing the outcome. Over a 2-year period, 64 benign cystic thyroid nodules in 62 patients were treated with EA. Several factors related to EA efficacy were evaluated, including the cystic component volume, volume and color of aspirates, degree of aspiration, and volume of injected ethanol. In all cases, we performed ultrasound follow-up for at least 12 months after the last EA session to evaluate the collapsed cystic component. The 64 treated nodules had aspirate colors that were red bloody (n = 3), dark bloody (n = 31), brownish (n = 15), greenish-yellow (n = 13), and colorless (n = 2). The degrees of aspiration were scant (n = 8), mild (n = 3), moderate (n = 8), and complete (n = 45). There was successful collapse of the cystic component after initial EA in 52 cases, but a repeat EA was employed in 12 failed cases. Statistical analysis showed that the degree of aspiration and color of aspirates correlated significantly with the success of EA. The results of this study suggest that complete aspiration of cystic contents was the most important factor in the efficacy of EA of benign cystic thyroid nodules, and greenish-yellow contents were closely related to scant or mild aspiration.

Experimental intraperitoneal injection of alcohol in rats: Peritoneal findings and histopathology.

PURPOSE: This study aimed to evaluate the macroscopic and microscopic peritoneal findings after intraperitoneal injection of alcohol in rats. METHODS: From January to February 2012, 20 male rats were used in this study: 15 rats received intraperitoneal injection of 0.1 mL 99.9% alcohol (group 1: experiment group) and 5 rats received intraperitoneal injection of 0.1 mL normal saline (group 2: control group). Animals from each group were sacrificed the day after alcohol injection and each week thereafter. Macroscopic and microscopic examinations of the peritonea and abdominal cavity were performed in each rat. RESULTS: There was no significant peritoneal abnormality on macroscopic view, except for a whitish-colored parietal peritoneum around the injection site in 3 animals from group 1. In all but 1 of the animals in group 1, mild to moderate peritoneal inflammation or fibrosis was observed 1 and 2 weeks after alcohol injection. However, the peritoneal abnormality of alcohol injection had dissipated by week 3. Peritoneal abnormalities were not observed in group 2. CONCLUSION: An intraperitoneal injection of alcohol in rats caused peritoneal inflammation or fibrosis during the first 2 weeks. However, these peritoneal abnormalities were short-lived and had completely disappeared after 3 weeks.

Coiling as Retreatment in Intracranial Aneurysm of de novo Formation or Regrowth: Case Report.

Development of de novo aneurysm or aneurysm regrowth after complete clipping of an intracranial aneurysm is rare. We report coiled cases of de novo aneurysm and aneurysm regrowth. We retrospectively reviewed 107 cases of intracranial aneurysm coiling performed in our hospital, identifying five cases of coiled aneurysm that were de novo aneurysm or aneurysm regrowth. In all the cases, total or near total occlusion was seen. There were no complications related to the procedure. In two of the three patients with ruptured aneurysms, consciousness level on admission was stupor. When the patient was discharged after the treatment, one of them had 4 of the modified Rankin Scale. The other one had 5 on discharge. The rest three patients had 0. As for a de novo aneurysm or a regrowth of aneurysm, coiling may be considered when clipping is difficult.

Ultrasound-guided fine-needle aspiration of thyroid nodules measuring less than 5 mm: effects on specimen adequacy and diagnosis.

OBJECTIVE: We aimed to assess the adequacy and efficacy of ultrasound (US)-guided fine-needle aspiration (US-FNA) for small solid thyroid nodules (SSTNs) with the largest diameter <5 mm and compared these according to nodule size. STUDY DESIGN: Among 656 SSTNs in 569 patients, each SSTN was classified into 1 of 4 groups according to the largest diameter: 1 mm ≤ group A < 2 mm; 2 mm ≤ group B < 3 mm; 3 mm ≤ group C < 4 mm, and 4 mm ≤ group D < 5 mm. We compared the adequacy and efficacy of US-FNA between these groups using histopathologic results as a reference standard. RESULTS: 571 (87.0%) SSTNs were adequately sampled by US-FNA and 200 of these were histopathologically confirmed. The adequacy of US-FNA for SSTNs varied according to the nodule diameter: the smaller the nodule diameter, the lower the diagnostic adequacy. The diagnostic efficacy of US-FNA for SSTNs showed a significant relationship with nodule size: diagnostic efficacy in groups A and B was lower than in groups C and D. CONCLUSIONS: The adequacy of US-FNA for SSTNs tended to decrease with decreased nodule size, and diagnostic efficacy of US-FNA for SSTNs with the largest diameter <3 mm was lower than for those ≥3 mm.

Solid and isoechoic thyroid nodules without malignant sonographic features: comparison of malignancy rate according to nodule size, shape and color Doppler pattern.

This study aimed to assess the malignancy rate of solid and isoechoic thyroid nodules without malignant sonographic features (SITNs) and to compare the malignant and benign SITNs according to nodule size, shape and color Doppler pattern. Of 382 SITNs with the largest diameter ≥10 mm, nodule size, nodule shape (i.e. spherical vs. ovoid) and color Doppler pattern (i.e. scant, peripheral, central, and mixed type) of each nodule were retrospectively evaluated. A total of 114 SITNs were histopathologically confirmed by surgery (called surgical SITN) and the malignancy rate of surgical SITNs was 8.8% (10/114). There was no statistical association between the incidence of malignancy of SITNs and nodule size but the malignancy rate of spherical SITNs was higher than that of ovoid SITNs. A significant relationship between peripheral vascularity of SITNs and benignity was found but the other vascularity patterns showed no significant association with malignancy or benignity of SITNs.

Transvenous embolization of cavernous sinus dural arteriovenous fistula using the direct superior ophthalmic vein approach: a case report.

Transvenous coil embolization has been successfully applied for the treatment of cavernous sinus dural arteriovenous fistula (CSDAVF). Unfortunately, the technique cannot be applied in cases of poor or absent inferior petrosal sinus or facial venous access route to the fistula. Recently, we experienced a successful embolization using direct superior ophthalmic vein approach in cases of CSDAVF which were no opacification of inferior petrosal sinus or facial vein.

Differentiation between benign and malignant solid thyroid nodules using an US classification system.

OBJECTIVE: To evaluate the diagnostic accuracy of a new ultrasound (US) classification system for differentiating between benign and malignant solid thyroid nodules. MATERIALS AND METHODS: In this study, we enrolled 191 consecutive patients who received real-time US and subsequent US diagnoses for solid thyroid nodules, and underwent US-guided fine-needle aspiration. Each thyroid nodule was prospectively classified into 1 of 5 diagnostic categories by real-time US: "malignant," "suspicious for malignancy," "borderline," "probably benign," and "benign". We evaluated the diagnostic accuracy of thyroid US and the cut-off US criteria by comparing the US diagnoses of thyroid nodules with cytopathologic results. RESULTS: Of the 191 solid nodules, 103 were subjected to thyroid surgery. US categories for these 191 nodules were malignant (n = 52), suspicious for malignancy (n = 16), borderline (n = 23), probably benign (n = 18), and benign (n = 82). A receiver-operating characteristic curve analysis revealed that the US diagnosis for solid thyroid nodules using the 5-category US classification system was very good. The sensitivity, specificity, positive and negative predictive values, and accuracy of US diagnosis were 86%, 95%, 91%, 92%, and 92%, respectively, when benign, probably benign, and borderline categories were collectively classified as benign (negative). CONCLUSION: The diagnostic accuracy of thyroid US for solid thyroid nodules is high when the above-mentioned US classification system is applied.

Sonographic findings of high-grade and non-high-grade ductal carcinoma in situ of the breast.

OBJECTIVE: The purpose of this study was to differentiate between high-grade and non-high-grade ductal carcinoma in situ (DCIS) of the breast on sonography. METHODS: From October 2003 to August 2009, 76 DCIS lesions in 73 women who underwent sonography and mammography were included in this study. Lesions were confirmed by mastectomy, breast-conserving surgery, or surgical biopsy. Images were analyzed by 2 radiologists with consensus and were correlated with histologic grades. RESULTS: Of the 76 lesions, 44 were classified as high--grade and 32 as non-high-grade DCIS. Fifty-seven lesions (75.0%) were identified on sonography, which revealed a mass in 30 cases, microcalcifications in 20, ductal changes in 4, and architectural distortion in 3. All cases with false-negative findings on sonography (n = 19) showed microcalcifications on mammography. On sonography, masses were more frequently found in non-high-grade (62.5%) than high-grade DCIS (22.7%; P < .01). No significant difference was seen in the sonographic features of masses between high-grade and non-high-grade DCIS. Microcalcifications were more common in high-grade (43.2%) than non-high-grade (3.1%) DCIS (P = .02). Most sonographically visible microcalcifications had associated findings such as ductal changes (n = 11), a mass (n = 7), or a hypoechoic area (n = 5). The detection rate of microcalcifications on sonography was higher in high-grade (62.9%) than non-high-grade DCIS (25.0%; P = .023). CONCLUSIONS: Microcalcifications with associated ductal changes (11 of 31 [35.5%]) were the most common sonographic findings in high-grade DCIS. An irregular hypoechoic mass with an indistinct and microlobulated margin (13 of 26 [50.0%]) was the most frequent finding in non-high-grade DCIS.

Use of self-expanding stents for the treatment of vertebral artery ostial stenosis: a single center experience.

OBJECTIVE: To evaluate our early experience using self-expanding stents to treat atherosclerotic vertebral artery ostial stenosis (VAOS), with respect to technical feasibility and clinical and imaging follow-up results. MATERIALS AND METHODS: A total of 20 lesions in 20 patients underwent stenting of the VAOS using a self-expanding stent (Precise RX; Cordis Neurovascular, Miami Lakes, FL). Two patients were asymptomatic. We analyzed the technical success rate, causes of technical failure, occurrence of any vascular or neurological event, and the occurrence of any neurological abnormality or in-stent restenosis (ISR) seen on follow-up. The imaging follow-up was performed with Doppler ultrasound (DUS) as a primary screening modality. RESULTS: One instance of technical failure was caused by failure of the guidewire passage. The stent diameter was 5 mm, and post-stenting balloon dilatations were necessary in all cases. Stent misplacement requiring placement of an additional stent occurred in four cases. Following a 14.8 month average clinical follow-up time, two patients showed anterior circulation ischemia, which was not attributed to the VAOS we treated. Following a 13.7 month average DUS follow-up, five patients showed a mild degree of diffuse or focal intimal thickening in the stent lumen; however, none of the stenosis showed luminal loss of more than 50% and no stent fracture was noted. CONCLUSION: The use of self-expanding stents for treating VAOS was technically feasible and helped to improve artery patency during our limited follow-up interval.

Diagnostic value of the anterior chamber depth of a globe on CT for detecting open-globe injury.

OBJECTIVES: To determine the diagnostic value of the anterior chamber depth (ACD) of a globe as seen on CT for detecting open-globe injury. METHODS: We enrolled 28 patients with unilateral open-globe injury confirmed by surgery and 28 controls with other types of orbital trauma. The diagnostic value of the difference of the ACDs between globes was evaluated by ROC analysis. The diagnostic performance of the following CT findings suggesting open-globe injury was also determined from independent analysis by two readers, i.e. change in the ACD and the globe contour, obvious volume loss of the globe, dislocated/deformed lens, intraocular foreign body/air and intraocular haemorrhage. RESULTS: The ACD measurements were possible only in 15 patients with open-globe injuries. A difference in the ACDs > or =0.4 mm resulted in 0.85 of the area under the ROC curve with a sensitivity of 73% and specificity of 100% (p = 0.0001). The presence of one or more of the CT findings had a sensitivity of 92%, specificity of 85% and diagnostic accuracy of 89%. CONCLUSIONS: Change in the ACD is a helpful CT finding for detecting open-globe injury. A difference in the ACDs > or =0.4 mm is a helpful diagnostic criterion with excellent specificity.