Papillary adenocarcinoma in submandibular region

Lateral ectopic thyroid is a rare event and even more uncommon is a primary malignancy in lateral ectopic thyroid. We present a case of papillary adenocarcinoma in lateral ectopic thyroid in submandibular space in a 55-year old male. To our knowledge this is the third case documented in the world and the first one in Europe. Lateral ectopic thyroid in this region is easily masqueraded as a submandibular gland swelling and so was our patients' tumor preliminarily diagnosed as a submandibular gland tumor. Furthermore, in the preoperative computed tomography (CT) scan the tissue was misinterpreted being adjacent to the submandibular gland. The diagnosis was revealed during the surgery and confirmed by the histology. This report demonstrates the difficulty in the differential diagnosis of neck masses. Although rare, ectopic tissue should be remembered as a possible diagnosis of all neck masses and the relevant preoperative examination should be performed by skilled professionals.Peer reviewe

Diagnostic Accuracy of MRI in Detecting the Perineural Spread of Head and Neck Tumors : A Systematic Review and Meta-Analysis

The purpose of this study was to review the diagnostic accuracy of MRI in detecting perineural spreading (PNS) of head and neck tumors using histopathological or surgical evidence from the afflicted nerve as the reference standard. Previous studies in the English language published in the last 30 years were searched from PubMed and Embase databases. We included studies that used magnetic resonance imaging (MRI) (with and without contrast enhancement) to detect PNS, as well as the histological or surgical confirmation of PNS, and that reported the exact numbers of patients required for assessing diagnostic accuracy. The outcome measures were sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Heterogeneity was assessed with the Higgins inconsistency test (I2). P-values smaller than 0.05 were considered statistically significant. A total of 11 retrospective studies were found, reporting 319 nerve samples from 245 patients. Meta-analytic estimates and their 95% confidence intervals were as follows: sensitivity 0.85 (0.70–0.95), specificity 0.85 (0.80–0.89), PPV 0.86 (0.70–0.94), and NPV 0.85 (0.71–0.93). We found statistically significant heterogeneity for sensitivity (I2 = 72%, p = 0.003) and PPV (I2 = 70%, p = 0.038), but not for NPV (I2 = 65%, p = 0.119) or specificity (I2 = 12%, p = 0.842). The most frequent MRI features of PNS were nerve enlargement and enhancement. Squamous cell carcinoma and adenoid cystic carcinoma were the most common tumor types, and the facial and trigeminal nerves were the most commonly affected nerves in PNS. Only a few studies provided examples of false MRI diagnoses. MRI demonstrated high diagnostic accuracy in depicting PNS of cranial nerves, yet this statement was based on scarce and heterogeneous evidence.© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).fi=vertaisarvioitu|en=peerReviewed

The natural course of bridging osteophyte formation on MRI—A pictorial illustration

Diffuse skeletal hyperostosis is a common spinal disorder, but its pathophysiology is mostly unclear. The disorder can lead to a variety of symptoms, but many patients remain relatively asymptomatic. We present a case demonstrating the development of bridging osteophytes on a series of magnetic resonance images. An elderly person's spine was scanned repeatedly due to non-specific back pain during the last 4 years and the consecutive images revealed the formation of a bony bridge in the lumbar spine. Extensive bone marrow edema was seen during the formation of the osteophyte, suggestive of an ongoing inflammatory process. This case underlines that the inflammatory reaction in diffuse skeletal hyperostosis can be intense and prolonged, and its role might be worth studying further.publishedVersionPeer reviewe

Segmentation of Striatal Brain Structures from High Resolution PET Images

We propose and evaluate an automatic segmentation method for extracting striatal brain structures (caudate, putamen, and ventral striatum) from parametric 11C-raclopride positron emission tomography (PET) brain images. We focus on the images acquired using a novel brain dedicated high-resolution (HRRT) PET scanner. The segmentation method first extracts the striatum using a deformable surface model and then divides the striatum into its substructures based on a graph partitioning algorithm. The weighted kernel k-means algorithm is used to partition the graph describing the voxel affinities within the striatum into the desired number of clusters. The method was experimentally validated with synthetic and real image data. The experiments showed that our method was able to automatically extract caudate, ventral striatum, and putamen from the images. Moreover, the putamen could be subdivided into anterior and posterior parts. An automatic method for the extraction of striatal structures from high-resolution PET images allows for inexpensive and reproducible extraction of the quantitative information from these images necessary in brain research and drug development

Diagnostic accuracy of contrast-enhanced CT for neck abscesses : A systematic review and meta-analysis of positive predictive value

Objectives To review the diagnostic accuracy of contrast-enhanced computed tomography (CT) in differentiating abscesses from cellulitis in patients with neck infections, using surgical findings as the reference standard. Materials and methods Previous studies in the last 32 years were searched from PubMed and Embase. Because of partial verification bias (only positive abscess findings are usually verified surgically), sensitivity and specificity estimates are unreliable, and we focused on positive predictive value (PPV). For all studies, PPV was calculated as the proportion of true positives out of all positives on imaging. To estimate pooled PPV, we used both the median with an interquartile range and a model-based estimate. For narrative purposes, we reviewed the utility of common morphological CT criteria for abscesses, such as central hypodensity, the size of the collection, bulging, rim enhancement, and presence of air, as well as sensitivity and specificity values reported by the original reports. Results 23 studies were found reporting 1453 patients, 14 studies in children (771 patients), two in adults (137 patients), and seven including all ages (545 patients). PPV ranged from 0.67 to 0.97 in individual studies, had a median of 0.84 (0.79–0.87), and a model-based pooled estimate of 0.83 (95% confidence interval 0.80–0.85). Most morphological CT criteria had considerable overlap between abscesses and cellulitis. Conclusions The pooled estimate of PPV is 0.83 for diagnosing neck abscesses with CT. False positives may be due to limited soft tissue contrast resolution. Overall, none of the morphological criteria seem to be highly accurate for differentiation between abscess and cellulitis.© 2022 Hagelberg et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.fi=vertaisarvioitu|en=peerReviewed

Turvetyöryhmän loppuraportti

Pääministeri Sanna Marinin hallitusohjelman mukaan turpeen energiakäyttö tulee vähintään puolittaa vuoteen 2030 mennessä ja muutoksen tulee tapahtua alueellisesti ja sosiaalisesti oikeudenmukaisella tavalla sähkön ja lämmön toimitus- ja huoltovarmuutta vaarantamatta. Työ- ja elinkeinoministeriö asetti kansallisen laaja-alaisen turvetyöryhmän 31.3.2020 valmistelemaan toimenpide-ehdotuksia em. tavoitteiden mukaisesti. Raportissa kuvataan turvealan nykytila ja arvioidut kehityssuunnat. Työryhmä katsoo, että suurimmat haasteet liittyvät turveyrittäjien tilanteen parantamiseen ja huolto- ja toimitusvarmuuden turvaamiseen, sillä turpeen energiakäyttö vähenee paljon aiempaa ennakoitua nopeammin. Nämä esitykset koostuvat turveliiketoiminnan lopettaville yrittäjille suunnatusta luopumispaketista sekä tuista turveyrittäjien siirtymiselle uuteen yritystoimintaan. Huoltovarmuuden osalta ehdotetuilla toimenpiteillä pyritään säilyttämään energiaturpeen tuotantovalmius ns. siirtymäkauden aikana. Raportti sisältää myös muita toimenpide-ehdotuksia esimerkiksi kasvu- ja kuiviketurpeen tuotannon turvaamisesta sekä turvesoiden jälkikäytöstä. Turvetyöryhmällä ei ole ollut mahdollisuutta arvioida ehdotusten valtiontukivaikutuksia. Valtiontukiin sekä JTF-rahastoon liittyviä kysymyksiä on selvitettävä poliittisessa jatkovalmistelussa

Novel Bioactive Glass Putty (S53P4) as Bone Graft Expander in Minimally Invasive Lumbosacral Interbody Fusion

Objective This study aimed to evaluate the clinically achieved interbody fusion rate in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) operations, when using a novel bioactive glass (BAG) S53P4 putty as bone graft expander together with local autologous bone (AB). A second purpose was to assess radiologically the subsidence of intervertebral cage into vertebral endplates. Methods We conducted a retrospective analysis of 20 patients operated on with MI-TLIF for 24 levels by a neurosurgeon in our clinic between 2014 and 2016. In addition to routine follow-up by static plain radiographs, the patients with special complaints were investigated with computed tomography (CT) and/or magnetic resonance imaging (MRI). An independent neuroradiologist analysed the interbody fusion by bridging bone criteria in CT scans and subsidence either in CT scans or in static plain radiographs. The patients were followed up to 12-24 months postoperative. Results The interbody fusion rate of 95.8% could be defined based on CT analysis of the symptomatic patients. Of the eight symptomatic patients, one had interbody cage dislocation of 2-3 mm posteriorly, lucency around a sacral screw and breakage of the other sacral screw. No subsidence of cages was observed. No postoperative infections were detected. Conclusion As bone graft expander, the novel BAG S53P4 putty provides at least as good interbody fusion results as the presently used bone graft expanders and enhancers with no observed subsidence or postoperative infections

Tekoäly radiologiassa

Erilaiset tekoälymenetelmät kehittyvät nopeasti, ja niiden käyttö myös lääketieteessä lisääntyy. Syväoppimisessa (deep learning) voidaan käyttää yhä laajempia (syvempiä) hermoverkkoja, jotka mahdollistavat aikaisempaa monimutkaisempien tehtävien ratkaisemisen. Teknisen kehityksen ansiosta tekoälytutkimus onkin nykyisin mahdollista myös yksittäisissä akateemisissa keskuksissa ilman mittavia kustannuksia. Radiologian alalla tekoälymenetelmien tutkimus on lisääntynyt viime vuosina eksponentiaalisesti. Suurin osa menetelmistä liittyy kuvien automaattiseen analysointiin, kuten poikkeavien löydösten tunnistukseen ja luokitteluun sekä rakenteiden segmentointiin. Tekoälymenetelmät tuskin korvaavat radiologin tekemää työtä lähitulevaisuudessa, mutta ne voivat tehostaa toimintaa ja vähentää inhimillisiä virheitä.</p

Emergency MRI in Spine Trauma of Children and Adolescents : A Pictorial Review

Severe spinal trauma is uncommon in the pediatric population, but due to the potentially devastating consequences of missed injury, it poses a diagnostic challenge in emergency departments. Diagnostic imaging is often needed to exclude or confirm the injury and to assess its extent. Magnetic resonance imaging (MRI) offers an excellent view of both bony and soft tissue structures and their traumatic findings without exposing children to ionizing radiation. Our pictorial review aims to demonstrate the typical traumatic findings, physiological phenomena, and potential pitfalls of emergency MRI in the trauma of the growing spine.Peer reviewe

Practical aspects of sentinel node biopsy in oral cavity cancer: all nodes that emit a signal are important

Background and objectivesSentinel node biopsy (SNB) is a safe and effective way to examine an N0 neck in early-stage oral cavity cancer (OCC). In this study, we evaluated the variables of SNB detection, surgery, and outcome.Material and methods Ninety-two patients with N0 OCC examined with SNB were included. Number and brightness of nodes detected on preoperative imaging and during surgery were analyzed and compared with histological findings. Patients with recurrent disease were evaluated separately and the effect of smoking and alcohol consumption was analyzed.ResultsEighteen patients had at least malignant cells in the sentinel lymph node (SLN); 18 patients had recurrent disease and nine patients died from the cancer. The negative predictive value of SNB was 95%. Six patients did not have metastases in the node with the strongest signal, but metastases were found in an SLN with a weaker signal. Smoking and alcohol consumption did not affect disease-specific or overall survival.Conclusion and significanceSNB has been confirmed to be safe and effective in early stage N0 OCC. However, it is important to carefully harvest up to four hottest SLNs that emit a signal. Treatment of patients with only isolated tumor cells (ITC) in the SLN appears to be necessary.</p