Diagnosticul ultrasonografic al nodulilor tiroidieni: actualităţi şi perspective

Universitatea de Medicină şi Farmacie Iuliu Haţieganu, Cluj-NapocaUltrasonografia este metoda imagistică cea mai larg accesibilă și eficientă, din punct de vedere al costului, pentru evaluarea morfologică a tiroidei și a maselor cervicale. În aprecierea nodulilor tiroidieni, fie că sunt unici sau aparţin unei guși multinodulare, pricipalul rol al ecografiei este acela de a indica nodulii suspecţi a reprezenta cancer papilar, în vederea evaluării lor ulterioare prin puncţie aspirativă cu ac fin. Criteriile ecografice care indică malignitatea unui nodul tiroidian sunt: hipoecogenitate marcată, halou întrerupt, contur neregulat/invaziv, microcalcificări punctate sau calcificări centrale, calcificare anulară discontinuă, aspect „mai mult înalt decât lat”, vascularizaţie centrală crescută cu halou hipovascular și creștere accelerată a volumului la urmărirea evoluţiei. Limfadenopatia malignă și extensia extratiroidiană sunt semne tardive. Se prezintă, de asemenea, și semnele evocatoare pentru caracterul benign al nodulilor tiroidieni. Este discutat rolul actual al elastografiei și al examinării cu contrast. Sunt prezentate aspecte particulare ale unor tumori tiroidiene, precum și aspecte care permit diferenţierea paratiroidelor anormale de nodulii tiroidieni. La final sunt discutate principalele probleme de diagnostic diferenţial și sunt prezentate algoritme de diagnostic

Cost Analysis on Imaging Diagnostic Techniques in Cerebral and Abdominal Neonatal Pathology

Background: Improvement of health care quality and cost control are the main aims of the health care reform in Romania. Objective: The aims of the research are to analyse the trend of costs for imaging techniques used as diagnostic tools for cerebral and abdominal neonatal pathology and to study the relationship between cost and diagnostic benefits. Design: This is a retrospective observational study design without a control group, conducted in the Radio-Imaging Department, Cluj District University Hospital, Romania, from October 2000 to February 2006. Patients: The study population was represented by neonates investigated in the Radio-Imaging Department, Cluj District University Hospital. Intervention: Five imaging diagnostic techniques used in the diagnosis of cerebral and abdominal neonatal pathology were investigated. Measurements: The costs of the investigated techniques were calculated. The concordance between clinical and imaging diagnostic was recorded. Results: Magnetic resonance proved to be the most expensive investigation. The rate between the raising of costs on investigation type on year was constant. The average cost of imaging investigations for patients with identified pathological aspects (€ 42.72) was not statistically significant (p > 0.05) compared with the average cost for patients with no pathologic imaging aspects (€ 37.62). The concordance between the clinical suspicion and the radio-imaging diagnosis was of 52.35%. Conclusions: The raise of radio-imaging investigation costs had a decreasing tendency over the years studied, decrease explained by the stabilization of the Romanian monetary market. The results on concordance analysis lead to the necessity of training of both clinicians and radiologists

Contrast-Enhanced Ultrasonography in the Diagnosis and Treatment Modulation of Breast Cancer

The aim of this paper is to highlight the role of contrast-enhanced ultrasound in breast cancer in terms of diagnosis, staging and follow-up of the post-treatment response. Contrast-enhanced ultrasound (CEUS) is successfully used to diagnose multiple pathologies and has also clinical relevance in breast cancer. CEUS has high accuracy in differentiating benign from malignant lesions by analyzing the enhancement characteristics and calculating the time-intensity curve’s quantitative parameters. It also has a significant role in axillary staging, especially when the lymph nodes are not suspicious on clinical examination and have a normal appearance on gray-scale ultrasound. The most significant clinical impact consists of predicting the response to neoadjuvant chemotherapy, which offers the possibility of adjusting the therapy by dynamically evaluating the patient. CEUS is a high-performance, feasible, non-irradiating, accessible, easy-to-implement imaging method and has proven to be a valuable addition to breast ultrasound

Musculoskeletal sonoelastography. Pictorial essay

Ultrasonic elastography (real-time elastography, sonoelastography) is a new ultrasound technique being one of the imaging mainstream in the last few years being used for characterizing soft tissue lesions, like breast, thyroid, prostate and lymph nodes. Musculoskeletal pathology was one of the first applications of sonoelastography, but, nevertheless the method is not yet standardized. The purpose of this pictorial essay is to briefly describe the technique and to exemplify the aspects of a variety of musculoskeletal pathologies

The value of a new score for sonoelastographic differentiation between benign and malignant cervical lymph nodes

Abstract Objective: The aim of this study is to explore the diagnostic value of sonoelastography for the differentiation between benign and malignant superficial lymph nodes of the neck. In this respect the utility of an original scoring system was explored. Material and method: Over a period of 30 months the patients examined routinely for the assessment of superficial lymph nodes of the neck were recorded in a data base containing grey-scale, Doppler and sonoelastographic information and images. The sonoelastographic images of 30 benign and 39 malignant lymph nodes were assessed. The images were scored according to a new, eight pattern scoring system proposed by our group. Interobserver agreement and area under the ROC curve (AUROC) for the differentiation between benign vs. malignant and benign vs. metastatic nodes were analyzed. Results: The analysis of the interobserver agreement for the investigated score provided a weighted Kappa = 0.687, 95%CI [0.572 to 0.802] and standard error = 0.059. In the differentiation benign -malignant, the AUROC was 0.846, with sensitivity of 66.67% and specificity of 96.67% for score >3. In the differentiation between benign and metastasis, the same criterion provided an AUROC of 0.855, with sensitivity of 71.43 and specificity of 96.67%. Conclusions: Our study suggests that applying the proposed score provides good interobserver agreement. The score also provided very good specificity and reasonable sensitivity in the differentiation between malignant and benign lymph nodes in the neck