Performance of contrast-enhanced ultrasound in thyroid nodules : Review of current state and future perspectives

Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.Ultrasound has been established as a baseline imaging technique for thyroid nodules. The main advantage of adding CEUS is the ability to assess the sequence and intensity of vascular perfusion and hemodynamics in the thyroid nodule, thus providing real-time characterization of nodule features, considered a valuable new approach in the determination of benign vs. malignant nod-ules. Original studies, reviews and six meta-analyses were included in this article. A total of 624 studies were retrieved, and 107 were included in the study. As recognized for thyroid nodule malignancy risk stratification by US, for acceptable accuracy in malignancy a combination of several CEUS parameters should be applied: hypo-enhancement, heterogeneous, peripheral irregular enhancement in combination with internal enhancement patterns, and slow wash-in and wash-out curve lower than in normal thyroid tissue. In contrast, homogeneous, intense enhancement with smooth rim enhancement and “fast-in and slow-out” are indicative of the benignity of the thyroid nodule. Even though overlapping features require standardization, with further research, CEUS may achieve reliable performance in detecting or excluding thyroid cancer. It can also play an op-erative role in guiding ablation procedures of benign and malignant thyroid nodules and metastatic lymph nodes, and providing accurate follow-up imaging to assess treatment efficacy.publishersversionPeer reviewe

Contrast-Enhanced Ultrasound Qualitative and Quantitative Characteristics of Parathyroid Gland Lesions

Funding Information: Funding: This research received funding from Latvian Science Funding, project number Izp-2020/2-0297, Multiparametric ultrasound correlation with morphology in patients with primary hyperparathyroidism. Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.Background and Objectives: preoperative differentiation of enlarged parathyroid glands may be challenging in conventional B-mode ultrasound. The aim of our study was to analyse qualitative and quantitative characteristics of parathyroid gland lesions, using multiparametric ultrasound protocol—B-mode, Colour Doppler (CD), and contrast-enhanced ultrasound (CEUS)— and to evaluate correlation with morphology in patients with hyperparathyroidism (HPT). Materials and Methods: consecutive 75 patients with 88 parathyroid lesions and biochemically confirmed HPT prior to parathyroidectomy were enrolled in the prospective study. B-mode ultrasound, CD, and CEUS were performed with the subsequent qualitative and quantitative evaluation of acquired data. We used 1 mL or 2 mL of intravenous ultrasound contrast agent during the CEUS examination. Correlation with post-surgical morphology was evaluated. Results: seventy parathyroid adenomas were hypoechoic and well contoured with increased central echogenicity (44.3%), peripheral-central vascularization (47%), and polar feeding vessel (100%). Twelve hyperplasias presented with similar ultrasound appearance and were smaller in volume (p = 0.036). Hyperplasias had a tendency for homogenous, marked intense enhancement vs. peripherally enhanced adenomas with central wash-out in CEUS after quantitative analysis. No significant difference was observed in contrasting dynamics, regardless of contrast media volume use (1 mL vs. 2 mL). We achieved 90.9% sensitivity and 72.7% specificity, 93% positive predictive value (PPV), 87.3% negative predictive value (NPV), and 87.3% accuracy in the differentiation of parathyroid lesions prior to post-processing. In a quantitative lesion analysis, our sensitivity increased up to 98%, specificity 80%, PPV 98%, and NPV 80% with an accuracy of 96.4%. Conclusions: CEUS of parathyroid lesions shows potential in the differentiation of adenoma from hyperplasia, regardless of the amount of contrast media injected. The quantitative analysis improved the sensitivity and specificity of differentiation between parathyroid lesions. Hyperplasia was characterized by homogeneous enhancement, fast uptake, and homogeneous wash-out appearance; adenoma—by peripheral uptake, central wash-out, and reduced hemodynamics. The use of CEUS quantification methods are advised to improve the ultrasound diagnostic role in suspected parathyroid lesions.publishersversionPeer reviewe

Recurrent Prostate Cancer Diagnostics with 18F-PSMA-1007 PET/CT: A Systematic Review of the Current State

Funding Information: This research was funded by Latvian Council of Science, grant number: lzp-2019/1-0056 “Impact of Targeted Molecular Imaging with 18F-PSMA-1007 and 68Ga-PSMA-11 PET/CT in Multimodal Evaluation of Recurrent Prostate Cancer”. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 101008571 (PRISMAP). This document reflects only the view of the author(s). The funding agenc(y/ies) is/are not responsible for any use that may be made of the information it contains. Publisher Copyright: © 2022 by the authors.BACKGROUND: Early diagnosis of recurrent prostate cancer is a cornerstone for further adequate therapy planning. Therefore, clinical practice and research still focuses on diagnostic tools that can detect prostate cancer in early recurrence when it is undetectable in conventional diagnostic imaging. 18F-PSMA-1007 PET/CT is a novel method to evaluate patients with biochemical recurrent PCa. The aim of this review was to evaluate the role of 18F-PSMA-1007 PET/CT in prostate cancer local recurrence, lymph node metastases and bone metastases detection. METHODS: Original studies, reviews and five meta-analyses were included in this article. A total of 70 studies were retrieved, 31 were included in the study. RESULTS: All patients described in the studies underwent 18F-PSMA-1007 PET/CT. The administered 18F-PSMA-1007 individual dose ranged from 159 ± 31 MBq to 363.93 ± 69.40 MBq. Results showed that 18F-PSMA-1007 PET/CT demonstrates a good detection rate in recurrent prostate cancer. CONCLUSIONS: 18F-PSMA-1007 PET/CT appears to achieve reliable performance in detecting recurrent prostate cancer. The high detection rate of 18F-PSMA-1007 PET/CT in recurrent prostate cancer was confirmed, especially in local recurrence and small lymph nodes with non-specific characteristics on conventional diagnostic imaging methods. However, several authors emphasize some limitations for this tracer-for example, non-specific uptake in bone lesions that can mimic bone metastases.publishersversionPeer reviewe

Large Parathyroid Tumor 8 Years after Thyroid Surgery : A Case Report

Funding Information: This case report was funded by the Fundamental and Useful Research Project (FLPP) within the project “Multiparametric ultrasound correlation with morphology in patients with primary hyperparathyroidism [Nr. lzp-2020/2-0297].” The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2022 S. Karger AG. All rights reserved.This report represents an unusually large parathyroid carcinoma (PC) mimicking thyroid nodule recurrence after hemithyroidectomy. PC is a rare endocrine malignancy accounting for less than 1% of hyperparathyroidism cases. This is the first case report where contrast-enhanced ultrasound (CEUS) was performed on a PC. A 63-year-old female presented with an enlarged mass on the left side of the neck. In 2012, left-side hemithyroidectomy was done due to a benign goiter. In 2020, laboratory analysis showed markedly elevated parathyroid hormone and calcium. Multiparametric neck ultrasonography was performed including B-mode, color Doppler, shear wave elastography, and CEUS. Computed tomography revealed an irregular mass in proximity to the trachea, esophagus, and dislocation of the common carotid artery. Perifocal fatty tissue appeared normal. Scintigraphy displayed a suspected parathyroid tumor or a suspected left lobe nodule of thyroid. Based on the biochemical diagnosis of primary hyperparathyroidism and radiological examinations, a suspected parathyroid tumor was considered. Intraoperative findings demonstrated an unusually large 9 × 6 cm tumor (84 g) adjacent to the common carotid artery anterolaterally and the recurrent laryngeal nerve medially. Pathohistological examination revealed a tumor solid in structure, with focal necrosis penetrating the capsule. Immunohistochemical analysis was positive for chromogranin, CD56, and Ki-67 (8–10%) and negative for CK20 and CK7. The morphological and immunohistochemical results correspond to PC. PC is a challenging diagnosis requiring a multidisciplinary approach, especially in the case of previous neck surgery. The only curative treatment for PC is radical surgery. Lifelong monitoring of PCs is mandatory due to the high recurrence rate.publishersversionPeer reviewe

KVANTITATĪVA MRI DIFŪZIJAS UZSVĒRTO ATTĒLU NOZĪME KOLOREKTĀLU PACIENTU STADIJAS NOTEIKŠANĀ: KLĪNISKĀ UN HISTOPATOLOĢISKĀ KORELĀCIJA

MedicīnaVeselības aprūpeMedicineHealth CareMērķi. Kolorektālā vēža (CRC) diagnostikas un stadijas uzstādīšanas izvēles metode ir magnētiskā rezonanse (MR) augstās jutības un specifiskuma dēļ. Ir pierādīts, ka MRI-DWI ADC vērtības prognozē lokālu kolorektālā vēža progresēšanu. Darba mērķis bija izpētīt MRI DWI attēlveidošanas kvantitatīvā ADC mērījuma lietderību, nosakot CRC lokālo progresēšanu un to saistību ar histopatoloģiskajiem rezultātiem. Materiāls un metodes. Retrospektīvā pētījumā tika iekļauti deviņdesmit seši CRC pacienti (F:M; 46:50M), vidējais vecums 68,5 g (diapazons 41-84). Visi dalībnieki tika izmeklēti ar 1,5 T MRI, ieskaitot T2, DWI sekvences. Šķietamā difūzijas koeficienta (ADC) vidējās vērtības (× 10–3 mm2/s) tika aprēķinātas, izmantojot interesējošo reģionu (ROI), kura izmērs ir 7–20 mm2 3 dažādās hipointensīvās audzēja zonās (T-ADC) un 1 zonā limfmezglu metastāzē (N-ADC). Ekstramurālā asinsvadu invāzija (EMVI) un mezorektālās fascijas (MRF) iesaiste tika novērtēta T2WI. TNM tika klasificēts saskaņā ar Brierley et al. (cTNM). Rezultāti. Audzēji tika klasificēti: I stadija (n=5), II (n=10) III (n=66), IV (n=14). T-ADC vidējā vērtība bija 0,726 (IQR 0,634-0,808), N-ADC 0,748 (IQR 0,668-0,808). T-ADC uzrādīja mērenu korelāciju ar N-ADC (rs=0,529;p<0,001), vāju korelāciju ar vēža stadiju (rs=-0,210;p=0,04), tendenci uz zemāku vērtību augstākam cT (rs=-0,266;p =0,027). cT korelēja ar cN (rs=0,233; p=0,022) un pG (rs=0,311; p=0,004). cN uzrādīja vāju korelāciju ar cM (rs=0,279; p=0,006). ECOG stadija tika korelēta ar pacienta vecumu (r=0,350; p=0,001). EMVI bija pozitīvs 40 (42%) gadījumos, MRF iesaiste 24 (33%) gadījumos. EMVI uzrādīja statistiski nozīmīgu saistību ar MRF (Chi2=4,389;p=0,036). MRF iesaite bija vairāk izplatīta zemāk diferencētos audzējos (Chi2 = 7,383; p = 0,025) Secinājumi. MRI DWI kvantitatīvā audzēja un metastātiskā limfmezglu zemās ADC vērtības korelē ar augstāku T stadiju, bet nekorelēja ar pacienta vecumu, ECOG stadiju, EMVI vai audzēja pakāpi. MRF iesaite bija vairāk izplatīta zemāk diferencētos audzējos.Objectives. The method of choice for the diagnostics and staging of colorectal cancer (CRC) is magnetic resonance imaging (MRI) due to high reported sensitivity and specificity. MRI-DWI ADC values have been shown to predict local advancement of colorectal cancer. The aim was to investigate the usefulness of MRI DWI imaging quantitative ADC measurement in determining local advancement of CRC and its relations to histopathological results. Material and methods. Ninety-six CRC patients (F:M; 46:50M), mean age 68.5y (range 41-84), were included in retrospective study. All participants received an MRI of 1.5T including T2, DWI sequences. Apparent diffusion coefficient (ADC) mean values (× 10−3 mm2/s) were calculated using region of interest (ROI) the size of 7-20 mm2 in 3 different hypointense areas of the tumour (T-ADC) and 1 area for a lymph node metastasis (N-ADC). Extramural vascular invasion (EMVI) and mesorectal fascia (MRF) involvement were assessed on T2WI. TNM were classified according to Brierley et al. (cTNM). Results. Tumours were graded: Stage I (n=5), II (n=10) III (n=66), IV (n=14). Median value for T-ADC was 0.726 (IQR 0.634-0.808), for N-ADC it was 0.748 (IQR 0.668-0.808). T-ADC showed a moderate correlation to N-ADC (rs=0.529;p<0.001), weak to cancer stage (rs=-0.210;p=0.04), tendency for lower value in higher cT (rs=-0.266;p=0.027). cT correlated to cN (rs=0.233;p=0.022) and pG (rs=0.311;p=0.004). cN showed a weak correlation to cM (rs=0.279;p=0.006). ECOG stage was correlated to patient’s age (r=0.350;p=0.001). EMVI was present in 40 (42%) cases, MRF involvement in 24 (33%) cases. EMVI showed a statistically significant association to MRF (Chi2=4.389;p=0.036). MRF was more prevalent in higher grade tumors (Chi2=7.383;p=0.025) Conclusions. MRI DWI quantitative tumor and metastatic lymph node low ADC values correlate with higher T stage but did not correlate with patients age, ECOG stage, EMVI or tumor grade. MRF was more prevalent in higher grade tumours

Can intratumoural vascularisation CT contrast dynamics help differentiate malignant renal tumour subtypes?

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