Objective:To evaluate the diagnostic value of ultrasound in isoechoic and hyperechoic thyroid nodules.Methods:A retrospectively analysis was performed on the ultrasonographic data of 128 cases of isoechoic and hyperechoic thyroid nodules confirmed by surgery and pathology at the Third Affiliated Hospital of Soochow University from August 2019 to December 2020. Based on the pathological results as the gold standard, there were 94 cases of benign nodules and 34 cases of malignant nodules. The ultrasonic features of nodules, including echo, margin, growth mode, calcification, halo, echo texture, posterior echo, nodule-in-nodule architecture, cystic change, and blood flow, were evaluated. Independent sample t-test, χ2 test, or Fisher's exact test was used for statistical comparison of ultrasonic features between groups. The diagnostic efficacy of each parameter was analyzed using the receiver operating characteristic (ROC) curve and the area under curve (AUC).Results:In the benign and malignant groups, irregular margin of the nodule (38.2% vs 5.3%, P＜0.001), vertical growth (17.6% vs 2.1%, P=0.004), calcification (73.5% vs 17.0%, P＜0.001), uneven echo texture (94.1% vs 55.3%, χ2=16.53, P＜0.001), and a little blood flow (79.4% vs 57.4%, P=0.017) all suggested the risk of malignancy. There was no difference in the presence or absence of halo between the two groups (P＞0.05). In nodules with halo, inconsistent halo thickness (84.2% vs 8.2%, χ2=37.58, P＜0.001) suggested the risk of malignancy. The diagnostic sensitivity of uneven echo texture of nodules (94.12%) was the highest, and the diagnostic specificity of vertical growth (97.87%) was the highest. The AUC and diagnostic accuracy of inconsistent sound halo thickness were the highest (0.880 and 89.71%, respectively).Conclusion:Isoechoic and hyperechoic nodules with irregular edges, vertical growth, coarse calcification or microcalcification, inconsistent thickness of acoustic halo, uneven echo texture, and a little blood supply are helpful to the diagnosis of malignant nodules.

患者女性,30岁,因"左侧颈部肿物3年伴快速增大3个月余"入院.患者3年前无意中发现左侧颈部芝麻粒大小肿物,一直未予检查及处理.2年前外院曾行鼻部肿物切除术,术后病理示:(鼻腔)Rosai-Dorfmnan病(Rosai-Dorfman disease,RDD),术后无后续治疗.

Objective:To assess the value of conventional sonographic characteristics of thyroid nodules combined with internal coarse calcification in differentiating benign and malignant thyroid nodules.Methods:The ultrasonographic data of 217 patients with 229 thyroid nodules confirmed by pathology at Changzhou First People's Hospital from January 2018 to July 2020 were retrospectively analyzed. Ultrasonography of the included nodules showed that there were coarse calcifications in the nodules. According to the gold standard of pathological results, the nodules were divided into either a benign (n=110) or a malignant (n=119) group. The conventional sonographic characteristics of nodules including maximum diameter, anteroposterior/transverse diameter ratio, echo intensity, growth pattern, composition, margin, and color Doppler flow imaging, and sonographic characteristics of coarse calcification including thickness, calcification interruption, morphology, margin of soft tissue outside the calcification, echo consistency, and location were analyzed retrospectively. Univariate analysis was used to compare the conventional sonographic characteristics of nodules and coarse calcification in nodules between the two groups. Binary logistic regression was used to establish prediction models of conventional nodule characteristics (model 1) and the comprehensive characteristics of nodules and coarse calcification (model 2). The diagnostic performance of each parameter and the combined model was compared by receiver operating characteristic curve (ROC) analysis and Z-test.Results:The maximum diameter of thyroid nodules ≤1.25 cm, anteroposterior/transverse diameter ratio >0.78, being solid, vertical growth, irregular margin or extra-thyroidal extension, as well as irregular thickness, interruption, echo inconsistency, soft tissue edge ,and central type of coarse calcification were significantly more common in the malignant group than in the benign group (P＜0.05). Model 1 included the maximum diameter, anteroposterior/transverse diameter ratio, and margin of the nodule. In model 2, the maximum diameter of nodule, anteroposterior/transverse diameter ratio, and calcification thickness, interruption, and location were included. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of model 2 were 81.85%, 82.73%, 82.29%, 80.18%, and 81.22%, respectively. The area under the curve was 0.877, which was significantly higher than that of model 1 (0.753; Z=4.197, P＜0.001).Conclusion:Sonographic characteristics such as irregular thickness, interruption, and central calcification in nodules are helpful for the diagnosis of malignant nodules. While observing the sonographic characteristics of thyroid nodules, it is important to evaluate the characteristics of internal coarse calcification in order to better distinguish benign and malignant thyroid nodules.

磨玻璃结节(GGN)是指在薄层肺窗CT影像上观察到局部密度增加,但不遮盖肺内血管和支气管的模糊影.肺癌筛查中可以检出影像表现为GGN且病理结果 为肺腺癌的病人.影像表现为GGN肺腺癌病理亚型不尽相同,早期诊断和准确鉴别对病人的治疗及改善预后具有重要的临床价值.就GGN的CT、MRI及PET/CT影像特征在鉴别表现为GGN的肺腺癌病理亚型方面的研究进展予以综述.

Superb microvascular imaging (SMI) is an innovative Doppler technique for vascular examination. It uses an intelligent algorithm that efficiently separates low-speed flow signals from motion artifacts so that it can assess microvessels and the vessel distribution in detail. This article reviews the clinical applications of SMI in the disorders of superficial tissues and organs including thyroid nodules, breast tumors and lymph node diseases etc. More information of diseases that are closely associated with angiogenesis can be shown by SMI than other noninvasive examinations. Although some limitations exist, this safe and convenient technique is becoming acceptable and would play a more important role in disease diagnosis and therapeutic responses evaluation.

Rationale and Objectives: To evaluate qualitative and quantitative indicators generated from Dual-energy computed tomography (DECT) for preoperatively differentiating between invasive adenocarcinoma (IAC) and preinvasive or minimally invasive adenocarcinoma (MIA) lesions manifesting as ground-glass opacity-predominant (GGO-predominant) nodules. Materials and Methods: We retrospectively enrolled 143 cases of completely resected GGO-predominant lung adenocarcinoma with DECT examinations between December 2017 and July 2019. Qualitative and quantitative parameters of GGO-predominant nodules were compared after grouping nodules into IAC and preinvasive-MIA groups. A multivariate logistic regression models were used for analyzing these parameters. The diagnostic performance of different parameters was compared by receiver operating characteristic (ROC) curves and Z tests. Results: This study included 137 patients (58 years +/- 11; male: female = 52:91) with 143 GGO-predominant nodules. The proportion of margins, internal dilated/distorted/cut-off bronchi, internal thickened/stiff/distorted vasculature, pleural indentation, and vascular convergence were higher in the IAC group than in the preinvasive-MIA group, as were the maximum diameter (Dmax), the diameter of the solid component (Dsolid) and the enhanced monochromatic CT value at 40 keV-190 keV (CT40 keV-190 keV) (p range: 0.001-0.019). Logistic regression analyses revealed that margin, Dmax, and CT60 keV values were independent predictors of the IAC group. The area under the curve (AUC) for the combination of margin, Dmax, and CT60 keV was 0.896 (90.2% sensitivity, 70.7% specificity, 84.6% accuracy), which was significantly higher than that for each two of them (all p < 0.05). Conclusion: The combined prediction model generated from DECT allows for effective preoperative differentiation between IAC and preinvasive-MIA in GGO-predominant lung adenocarcinomas. (c) 2020 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.