RESUMO
AIM: To assess the positive predictive value (PPV) and inter-observer agreement of Thyroid Imaging Reporting and Data System (TIRADS) as described by Kwak et al. MATERIALS AND METHODS: This was a prospective study wherein ultrasound was performed by two radiologists on patients with thyroid nodules >1 cm. The third radiologist interpreted archived images. Ultrasound features and TIRADS category were compared with cytology and surgical histopathology. PPV was calculated for all readers' combined assessment. Inter-observer agreement was calculated using linear weighted kappa. RESULTS: A total of 238 patients with 272 nodules of mean size 2.9 ± 1.7 cm were included. PPV for malignancy was 6.6%, 32%, 36%, 64%, 59%, and 91% for TIRADS 2, 3, 4a, 4b, 4c, and 5 categories, respectively. Inter-observer agreement was substantial [kappa (k) = 0.61-0.80] for assessment of nodule echogenicity, margins, calcification, and shape and good (k = 0.570, P < 0.001) for assessment of composition of the thyroid nodules. Overall agreement between observers was substantial for assigning TIRADS category [multi-rater weighted kappa coefficient (wt k) = 0.721, P < 0.001]. CONCLUSIONS: TIRADS is a simple and practical method of assessing thyroid nodules with high PPV and good inter-observer agreement.
Assuntos
Falso Aneurisma/terapia , Cateterismo Periférico/efeitos adversos , Procedimentos Endovasculares , Doença Iatrogênica , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/terapia , Veia Subclávia/lesões , Lesões do Sistema Vascular/terapia , Adulto , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Flebografia/métodos , Punções , Insuficiência Renal Crônica/diagnóstico , Stents , Veia Subclávia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/etiologiaRESUMO
We report the case of a 35-year-old man from North India who presented with generalised tonic-clonic seizures and was found to have ring-enhancing brain lesions. He had a coincident adrenal mass lesion. Cultures from both regions grew Histoplasma capsulatum. He improved on treatment with itraconazole. This case is being reported since cerebral ring-enhancing lesions are rarely associated with histoplasmosis, and coincident adrenal involvement is also a rarity in an immunocompetent individual.
