The document discusses the Thyroid Imaging Reporting and Data System (TIRADS) which was developed to standardize the ultrasound reporting of thyroid nodules and stratify the risk of malignancy. It describes the original TIRADS classification proposed by Horvath et al. and modifications made by Kwak et al. Kwak et al's simplified classification categorizes nodules based on the number of suspicious ultrasound features present into TIRADS 3, 4a, 4b, 4c, and 5 risk groups. A later study by Fernández Sánchez further modified the scoring system to assign a point for each suspicious feature and lymph node observed on ultrasound.
This document provides an overview of ultrasound imaging of the thyroid and neck region. It describes the ultrasound appearance and features of normal thyroid anatomy, common thyroid pathologies including nodules, thyroiditis, and lymph nodes. Details are given on imaging techniques, vascular anatomy, and pathologies of the parathyroid glands and salivary glands.
Description of various ultrasound features of benign and suspicious thyroid nodules with multiple ultrasound systems for risk stratification of malignancy.
The document discusses the radiological anatomy of the scrotum, including normal gross anatomy, radiological anatomy using ultrasound and MRI, and various disorders. It covers the embryology of the scrotum and provides details on ultrasound assessment of the testis and epididymis, noting that testicular echogenicity and vascularity can help identify disorders. The role of ultrasound in testicular and scrotal trauma is also examined, alongside extratesticular scrotal masses. Diagrams and images are included to illustrate anatomical structures and various conditions.
presentation on ultrasound elastography-introduction ,techniques,physics,application, interpretation and future prospects.sourced from multiple articles.
Presentation1.pptx, radiological imaging of malignant breast diseases.Abdellah Nazeer
The document discusses various types of breast cancers and their radiological appearances. It begins by describing breast cancer in general, noting that it usually occurs in women and can begin in the ducts or lobules. It then summarizes the main types of breast cancers like ductal carcinoma in situ, invasive ductal carcinoma, invasive lobular carcinoma, inflammatory breast carcinoma, and rare types like mucinous carcinoma and phyllodes tumor. For each type, it provides details on their clinical and radiological features like mammography and MRI appearances to aid in diagnosis.
This document provides an overview of cerebellopontine angle masses, including their incidence, location, and radiographic features. It discusses the most common masses such as vestibular schwannoma (acoustic neuroma), CPA meningioma, and epidermoid cyst. For each type of mass, it describes their typical appearance on CT and MRI scans, including signal characteristics and enhancement patterns. It also provides differential diagnoses to help distinguish between different pathologies that can present in the CPA region. The goal is to help readers learn as much as possible about CPA masses to aid in successful diagnosis and management.
The document discusses the systematic approach to characterizing brain tumors on MRI. It describes three main steps: detection, localization, and characterization. Localization involves determining if a tumor is intra-axial or extra-axial based on signs like a CSF cleft between the brain and lesion. Characterization includes assessing features like enhancement pattern, border definition, and presence of necrosis to differentiate tumor types such as meningioma, schwannoma, glioma, and metastasis. The references provided give further information on diagnostic criteria.
Presentation1.pptx, radiological imaging of beign breast diseasesAbdellah Nazeer
This document summarizes radiological imaging findings of various benign breast diseases. It describes imaging modalities used and findings for conditions such as ductal ectasia with inspissated secretion, fibroadenoma, cystosarcoma phyllodes, fibrocystic disease, idiopathic granulomatous mastitis, lupus mastitis, epidermal inclusion cyst, perilobular hemangioma, and hydatid cyst. Dynamic contrast MRI, diffusion MRI, MR spectroscopy, and ultrasound findings are presented for some conditions like fibroadenoma. Cyst morphology and characteristics are also detailed.
This document provides an overview of ultrasound imaging of the thyroid and neck region. It describes the ultrasound appearance and features of normal thyroid anatomy, common thyroid pathologies including nodules, thyroiditis, and lymph nodes. Details are given on imaging techniques, vascular anatomy, and pathologies of the parathyroid glands and salivary glands.
Description of various ultrasound features of benign and suspicious thyroid nodules with multiple ultrasound systems for risk stratification of malignancy.
The document discusses the radiological anatomy of the scrotum, including normal gross anatomy, radiological anatomy using ultrasound and MRI, and various disorders. It covers the embryology of the scrotum and provides details on ultrasound assessment of the testis and epididymis, noting that testicular echogenicity and vascularity can help identify disorders. The role of ultrasound in testicular and scrotal trauma is also examined, alongside extratesticular scrotal masses. Diagrams and images are included to illustrate anatomical structures and various conditions.
presentation on ultrasound elastography-introduction ,techniques,physics,application, interpretation and future prospects.sourced from multiple articles.
Presentation1.pptx, radiological imaging of malignant breast diseases.Abdellah Nazeer
The document discusses various types of breast cancers and their radiological appearances. It begins by describing breast cancer in general, noting that it usually occurs in women and can begin in the ducts or lobules. It then summarizes the main types of breast cancers like ductal carcinoma in situ, invasive ductal carcinoma, invasive lobular carcinoma, inflammatory breast carcinoma, and rare types like mucinous carcinoma and phyllodes tumor. For each type, it provides details on their clinical and radiological features like mammography and MRI appearances to aid in diagnosis.
This document provides an overview of cerebellopontine angle masses, including their incidence, location, and radiographic features. It discusses the most common masses such as vestibular schwannoma (acoustic neuroma), CPA meningioma, and epidermoid cyst. For each type of mass, it describes their typical appearance on CT and MRI scans, including signal characteristics and enhancement patterns. It also provides differential diagnoses to help distinguish between different pathologies that can present in the CPA region. The goal is to help readers learn as much as possible about CPA masses to aid in successful diagnosis and management.
The document discusses the systematic approach to characterizing brain tumors on MRI. It describes three main steps: detection, localization, and characterization. Localization involves determining if a tumor is intra-axial or extra-axial based on signs like a CSF cleft between the brain and lesion. Characterization includes assessing features like enhancement pattern, border definition, and presence of necrosis to differentiate tumor types such as meningioma, schwannoma, glioma, and metastasis. The references provided give further information on diagnostic criteria.
Presentation1.pptx, radiological imaging of beign breast diseasesAbdellah Nazeer
This document summarizes radiological imaging findings of various benign breast diseases. It describes imaging modalities used and findings for conditions such as ductal ectasia with inspissated secretion, fibroadenoma, cystosarcoma phyllodes, fibrocystic disease, idiopathic granulomatous mastitis, lupus mastitis, epidermal inclusion cyst, perilobular hemangioma, and hydatid cyst. Dynamic contrast MRI, diffusion MRI, MR spectroscopy, and ultrasound findings are presented for some conditions like fibroadenoma. Cyst morphology and characteristics are also detailed.
This document provides an overview of scrotal ultrasound techniques and findings. It describes the anatomy seen on ultrasound and Doppler evaluation of the testes and epididymis. Common pathologies are discussed such as epididymitis, torsion, trauma, varicoceles, hydroceles, and germ cell tumors. Scanning protocols and minimum images required are outlined. Findings associated with different conditions like torsion and tumors are also detailed.
Presentation1, radiological imaging of endometrial carcinoma.Abdellah Nazeer
MRI is a valuable tool for assessing endometrial cancer by depicting tumor size, extension into the myometrium or parametrium, cervical invasion, and lymphadenopathy. It plays an important role in pre-operative planning by identifying high-risk features that may require lymph node dissection or adjuvant therapy. While endometrial cancer is surgically staged, MRI can accurately assess key features to guide treatment. It can also differentiate endometrial cancer from benign conditions like hyperplasia, adenomyosis, or fibroids.
The document discusses primary retroperitoneal neoplasms. It notes that 70-80% of primary retroperitoneal neoplasms are malignant in nature. The retroperitoneum contains mesodermal neoplasms, neurogenic tumors, germ cell and sex cord tumors, and lymphoid neoplasms. The most common primary retroperitoneal sarcomas are liposarcoma, leiomyosarcoma, and malignant fibrous histiocytoma. Neurogenic tumors such as schwannomas and neurofibromas are usually benign and occur in a younger age group. Teratomas are germ cell tumors that may contain fat, calcium, or sebum levels on imaging.
1. Cystic lesions are commonly seen in breast imaging and range from simple cysts to more complex cysts with solid components.
2. Simple cysts appear anechoic with thin walls and posterior enhancement, while complicated cysts have internal echoes and complex cysts have thick walls or solid components.
3. Differential diagnoses for cystic masses include galactoceles, hematomas, fat necrosis, abscesses, papillomas, and necrotic tumors. Careful evaluation of imaging features is needed to distinguish these entities.
1. The document describes the five deep neck spaces: anterior visceral space, carotid space, retropharyngeal space, posterior cervical space, and perivertebral space.
2. Each space is defined by its anatomical boundaries and contents, which can include viscera, blood vessels, nerves, lymph nodes, and pathologies such as tumors, infections, cysts.
3. CT and MRI images are presented to illustrate normal anatomy as well as various diseases found within the deep neck spaces, such as abscesses, aneurysms, lymphadenopathy, tumors.
Breast ultrasound uses high-frequency sound waves to map the internal structures of the breast. Though it should not be used alone for screening, ultrasound can detect cancers not seen on mammography when used together with mammography. With new transducers, ultrasound can also detect malignancy associated with clustered microcalcifications seen on mammograms. Ultrasound provides high quality images of the normal and abnormal breast and can help differentiate between cystic and solid lesions.
This document discusses the anatomy and ultrasound features of thyroid gland diseases. It provides indications for thyroid ultrasound such as enlargement, palpable or non-palpable masses, and abnormal thyroid function tests. Features of benign and malignant solitary nodules and diffuse diseases like Graves' disease and Hashimoto's thyroiditis are described. Benign nodules often appear completely cystic, echogenic or isoechoic with a complete halo and rim calcifications. Malignant nodules frequently have microcalcifications, irregular margins and hypervascularity. Diffuse diseases present with diffuse enlargement and vascular patterns. Ultrasound helps evaluate incidentally detected nodules.
This document discusses lumbosacral transitional vertebrae (LSTV), which are congenital spinal anomalies involving sacralization of the lowest lumbar segment or lumbarization of the highest sacral segment. LSTVs can be classified based on imaging features and involve fusion of the transverse process to the sacrum. Numbering the vertebrae can be challenging with LSTVs. Prediction of LSTVs on MRI is possible based on increased A and B angles on sagittal images, which measure the inclination of the sacrum and lumbar lordosis. LSTVs can cause low back pain known as Bertolotti syndrome through various mechanisms.
This document discusses diagnostic imaging techniques for evaluating lymph nodes in patients with head and neck cancer. It describes the use of ultrasound, CT, MRI, diffusion-weighted MRI, and PET imaging to analyze lymph node characteristics like size, shape, margins, echogenicity, necrosis and vascularity which can help differentiate between metastatic, inflammatory and normal lymph nodes. Quantitative measurements like ADC from diffusion MRI and SUV from PET can also provide diagnostic information and predict cancer spread and treatment response.
This document summarizes key findings on ultrasound examination of the thyroid gland and related structures. It describes the normal ultrasound appearance of the thyroid and measurements. It also discusses common pathologies seen on ultrasound such as Hashimoto's thyroiditis, Graves' disease, thyroid nodules, and lymph node enlargement. Additional sections cover the parathyroid glands, salivary glands, and neck lymph nodes. For each area, it provides ultrasound images along with descriptions of normal and abnormal findings.
Ultrasound is useful for evaluating breast lesions. It can differentiate between solid and cystic masses. Elastography further helps characterize lesions by assessing tissue stiffness. Benign lesions tend to be softer and more homogeneous while malignant lesions are typically stiffer and heterogeneous. Elastography can potentially upgrade or downgrade BI-RADS assessments. For example, a BI-RADS 3 lesion may be upgraded to 4 if seen as stiff on elastography, or a BI-RADS 4a lesion may be downgraded to 3 if appearing soft and homogeneous. Elastography provides additional information to ultrasound for more accurate characterization of breast abnormalities.
1. The document describes various gastrointestinal and musculoskeletal conditions seen on imaging. It includes descriptions of total colonic aganglionosis, retroperitoneal fibrosis, pectus excavatum, Reiter's syndrome, median arcuate ligament syndrome, and Haglund syndrome among others.
2. The conditions are described and key radiographic findings are highlighted, such as the displacement and tapering of ureters seen in retroperitoneal fibrosis. Common presentations, classifications, and distinguishing radiologic features are summarized for each condition.
3. Different imaging modalities are discussed, with CT and MRI findings provided where relevant to demonstrate characteristics of the various diseases and injuries.
The document describes the anatomy of the larynx based on a radiology report. It discusses the boundaries and divisions of the larynx and describes the cartilages that make up the laryngeal framework, including the thyroid, cricoid, and arytenoid cartilages. It also summarizes the imaging appearance of the larynx on computed tomography (CT) and magnetic resonance imaging (MRI).
This document discusses breast MRI protocols, techniques, and the interpretation of findings. It provides details on coil and patient positioning, recommended MRI field strength, and standard breast MRI protocols. It discusses recognizing normal enhancing structures like vessels, nipples, and lymph nodes. Guidelines are presented for analyzing lesion enhancement and characterizing benign masses based on criteria like smooth margins, shape, homogeneous enhancement, fat content, T2 signal, and rim enhancement. Examples of benign findings like fibroadenomas and fat-containing lesions are also described.
Radiological imaging of mediastinal massesPankaj Kaira
1. CT is the most important tool for evaluating mediastinal masses and characterizing their nature and extent.
2. Thymomas are the most common primary mediastinal neoplasm, typically occurring in patients over 40 and appearing on CT as well-defined solid masses in the anterior mediastinum that can demonstrate calcification.
3. CT is useful for staging thymomas and identifying features like invasion of surrounding tissues or distant metastases that indicate more advanced disease.
Progressive muscle weakness for 2 years. Giant cerebral aneurysms are greater than 25mm. Patients can present with mass effect or subarachnoid hemorrhage. On MRI, patent aneurysms appear as flow void or heterogeneous signal. Thrombosed aneurysms depend on clot age. Sturge-Weber syndrome is characterized by facial port wine stains and pial angiomas. CT detects subcortical calcification earlier than plain film. MRI shows signal changes and anatomical volume loss with age. État criblé describes diffusely widened perivascular spaces in the basal ganglia. External auditory canal atresia involves complete or incomplete bony atresia of the external auditory canal.
The document describes a case of a 27-year-old man presenting with chronic dry cough and referred for chest imaging. Chest x-ray revealed a well-defined round radio-opaque lesion in the left perihilar region. Further imaging found the mass to be arising from the left main bronchus in the middle mediastinum. Differential diagnoses included bronchogenic cysts and esophageal duplication cysts. Based on features of a sharply demarcated mass arising from the bronchus, the final diagnosis was determined to be a bronchogenic cyst, a congenital malformation of the bronchial tree.
Presentation1.pptx, radilogical imaging of ovarian lesions.Abdellah Nazeer
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is a common complication of sexually transmitted diseases. It can cause long-term issues like chronic pelvic pain, infertility, and ectopic pregnancy due to scarring and adhesions. PID includes conditions like endometritis, salpingitis, and tubo-ovarian abscess. Prompt diagnosis and treatment are important to prevent life-threatening complications due to the varied presentation and sometimes difficultly in detection of PID. Radiological imaging can help identify signs of PID and related conditions like tubo-ovarian abscesses.
Ueda2016 thyroid nodule in practice - khaled el hadidyueda2015
The document discusses thyroid nodules and guidelines for their evaluation and management. It provides definitions of thyroid nodules and discusses their prevalence in the population. Risk factors for malignancy are outlined. The American Thyroid Association guidelines from 2009 and 2015 are summarized, including recommendations on ultrasound characteristics warranting biopsy and nodule size thresholds for biopsy consideration. Systems for stratifying nodules based on ultrasound features, such as the TI-RADS system, are also covered briefly.
This document provides an overview of scrotal ultrasound techniques and findings. It describes the anatomy seen on ultrasound and Doppler evaluation of the testes and epididymis. Common pathologies are discussed such as epididymitis, torsion, trauma, varicoceles, hydroceles, and germ cell tumors. Scanning protocols and minimum images required are outlined. Findings associated with different conditions like torsion and tumors are also detailed.
Presentation1, radiological imaging of endometrial carcinoma.Abdellah Nazeer
MRI is a valuable tool for assessing endometrial cancer by depicting tumor size, extension into the myometrium or parametrium, cervical invasion, and lymphadenopathy. It plays an important role in pre-operative planning by identifying high-risk features that may require lymph node dissection or adjuvant therapy. While endometrial cancer is surgically staged, MRI can accurately assess key features to guide treatment. It can also differentiate endometrial cancer from benign conditions like hyperplasia, adenomyosis, or fibroids.
The document discusses primary retroperitoneal neoplasms. It notes that 70-80% of primary retroperitoneal neoplasms are malignant in nature. The retroperitoneum contains mesodermal neoplasms, neurogenic tumors, germ cell and sex cord tumors, and lymphoid neoplasms. The most common primary retroperitoneal sarcomas are liposarcoma, leiomyosarcoma, and malignant fibrous histiocytoma. Neurogenic tumors such as schwannomas and neurofibromas are usually benign and occur in a younger age group. Teratomas are germ cell tumors that may contain fat, calcium, or sebum levels on imaging.
1. Cystic lesions are commonly seen in breast imaging and range from simple cysts to more complex cysts with solid components.
2. Simple cysts appear anechoic with thin walls and posterior enhancement, while complicated cysts have internal echoes and complex cysts have thick walls or solid components.
3. Differential diagnoses for cystic masses include galactoceles, hematomas, fat necrosis, abscesses, papillomas, and necrotic tumors. Careful evaluation of imaging features is needed to distinguish these entities.
1. The document describes the five deep neck spaces: anterior visceral space, carotid space, retropharyngeal space, posterior cervical space, and perivertebral space.
2. Each space is defined by its anatomical boundaries and contents, which can include viscera, blood vessels, nerves, lymph nodes, and pathologies such as tumors, infections, cysts.
3. CT and MRI images are presented to illustrate normal anatomy as well as various diseases found within the deep neck spaces, such as abscesses, aneurysms, lymphadenopathy, tumors.
Breast ultrasound uses high-frequency sound waves to map the internal structures of the breast. Though it should not be used alone for screening, ultrasound can detect cancers not seen on mammography when used together with mammography. With new transducers, ultrasound can also detect malignancy associated with clustered microcalcifications seen on mammograms. Ultrasound provides high quality images of the normal and abnormal breast and can help differentiate between cystic and solid lesions.
This document discusses the anatomy and ultrasound features of thyroid gland diseases. It provides indications for thyroid ultrasound such as enlargement, palpable or non-palpable masses, and abnormal thyroid function tests. Features of benign and malignant solitary nodules and diffuse diseases like Graves' disease and Hashimoto's thyroiditis are described. Benign nodules often appear completely cystic, echogenic or isoechoic with a complete halo and rim calcifications. Malignant nodules frequently have microcalcifications, irregular margins and hypervascularity. Diffuse diseases present with diffuse enlargement and vascular patterns. Ultrasound helps evaluate incidentally detected nodules.
This document discusses lumbosacral transitional vertebrae (LSTV), which are congenital spinal anomalies involving sacralization of the lowest lumbar segment or lumbarization of the highest sacral segment. LSTVs can be classified based on imaging features and involve fusion of the transverse process to the sacrum. Numbering the vertebrae can be challenging with LSTVs. Prediction of LSTVs on MRI is possible based on increased A and B angles on sagittal images, which measure the inclination of the sacrum and lumbar lordosis. LSTVs can cause low back pain known as Bertolotti syndrome through various mechanisms.
This document discusses diagnostic imaging techniques for evaluating lymph nodes in patients with head and neck cancer. It describes the use of ultrasound, CT, MRI, diffusion-weighted MRI, and PET imaging to analyze lymph node characteristics like size, shape, margins, echogenicity, necrosis and vascularity which can help differentiate between metastatic, inflammatory and normal lymph nodes. Quantitative measurements like ADC from diffusion MRI and SUV from PET can also provide diagnostic information and predict cancer spread and treatment response.
This document summarizes key findings on ultrasound examination of the thyroid gland and related structures. It describes the normal ultrasound appearance of the thyroid and measurements. It also discusses common pathologies seen on ultrasound such as Hashimoto's thyroiditis, Graves' disease, thyroid nodules, and lymph node enlargement. Additional sections cover the parathyroid glands, salivary glands, and neck lymph nodes. For each area, it provides ultrasound images along with descriptions of normal and abnormal findings.
Ultrasound is useful for evaluating breast lesions. It can differentiate between solid and cystic masses. Elastography further helps characterize lesions by assessing tissue stiffness. Benign lesions tend to be softer and more homogeneous while malignant lesions are typically stiffer and heterogeneous. Elastography can potentially upgrade or downgrade BI-RADS assessments. For example, a BI-RADS 3 lesion may be upgraded to 4 if seen as stiff on elastography, or a BI-RADS 4a lesion may be downgraded to 3 if appearing soft and homogeneous. Elastography provides additional information to ultrasound for more accurate characterization of breast abnormalities.
1. The document describes various gastrointestinal and musculoskeletal conditions seen on imaging. It includes descriptions of total colonic aganglionosis, retroperitoneal fibrosis, pectus excavatum, Reiter's syndrome, median arcuate ligament syndrome, and Haglund syndrome among others.
2. The conditions are described and key radiographic findings are highlighted, such as the displacement and tapering of ureters seen in retroperitoneal fibrosis. Common presentations, classifications, and distinguishing radiologic features are summarized for each condition.
3. Different imaging modalities are discussed, with CT and MRI findings provided where relevant to demonstrate characteristics of the various diseases and injuries.
The document describes the anatomy of the larynx based on a radiology report. It discusses the boundaries and divisions of the larynx and describes the cartilages that make up the laryngeal framework, including the thyroid, cricoid, and arytenoid cartilages. It also summarizes the imaging appearance of the larynx on computed tomography (CT) and magnetic resonance imaging (MRI).
This document discusses breast MRI protocols, techniques, and the interpretation of findings. It provides details on coil and patient positioning, recommended MRI field strength, and standard breast MRI protocols. It discusses recognizing normal enhancing structures like vessels, nipples, and lymph nodes. Guidelines are presented for analyzing lesion enhancement and characterizing benign masses based on criteria like smooth margins, shape, homogeneous enhancement, fat content, T2 signal, and rim enhancement. Examples of benign findings like fibroadenomas and fat-containing lesions are also described.
Radiological imaging of mediastinal massesPankaj Kaira
1. CT is the most important tool for evaluating mediastinal masses and characterizing their nature and extent.
2. Thymomas are the most common primary mediastinal neoplasm, typically occurring in patients over 40 and appearing on CT as well-defined solid masses in the anterior mediastinum that can demonstrate calcification.
3. CT is useful for staging thymomas and identifying features like invasion of surrounding tissues or distant metastases that indicate more advanced disease.
Progressive muscle weakness for 2 years. Giant cerebral aneurysms are greater than 25mm. Patients can present with mass effect or subarachnoid hemorrhage. On MRI, patent aneurysms appear as flow void or heterogeneous signal. Thrombosed aneurysms depend on clot age. Sturge-Weber syndrome is characterized by facial port wine stains and pial angiomas. CT detects subcortical calcification earlier than plain film. MRI shows signal changes and anatomical volume loss with age. État criblé describes diffusely widened perivascular spaces in the basal ganglia. External auditory canal atresia involves complete or incomplete bony atresia of the external auditory canal.
The document describes a case of a 27-year-old man presenting with chronic dry cough and referred for chest imaging. Chest x-ray revealed a well-defined round radio-opaque lesion in the left perihilar region. Further imaging found the mass to be arising from the left main bronchus in the middle mediastinum. Differential diagnoses included bronchogenic cysts and esophageal duplication cysts. Based on features of a sharply demarcated mass arising from the bronchus, the final diagnosis was determined to be a bronchogenic cyst, a congenital malformation of the bronchial tree.
Presentation1.pptx, radilogical imaging of ovarian lesions.Abdellah Nazeer
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is a common complication of sexually transmitted diseases. It can cause long-term issues like chronic pelvic pain, infertility, and ectopic pregnancy due to scarring and adhesions. PID includes conditions like endometritis, salpingitis, and tubo-ovarian abscess. Prompt diagnosis and treatment are important to prevent life-threatening complications due to the varied presentation and sometimes difficultly in detection of PID. Radiological imaging can help identify signs of PID and related conditions like tubo-ovarian abscesses.
Ueda2016 thyroid nodule in practice - khaled el hadidyueda2015
The document discusses thyroid nodules and guidelines for their evaluation and management. It provides definitions of thyroid nodules and discusses their prevalence in the population. Risk factors for malignancy are outlined. The American Thyroid Association guidelines from 2009 and 2015 are summarized, including recommendations on ultrasound characteristics warranting biopsy and nodule size thresholds for biopsy consideration. Systems for stratifying nodules based on ultrasound features, such as the TI-RADS system, are also covered briefly.
This document discusses the anatomy, physiology, pathology, staging, diagnosis, and treatment of thyroid cancer. Some key points:
- The thyroid gland is located in the neck and produces thyroid hormones which regulate metabolism. Thyroid cancers are classified based on their level of differentiation.
- Diagnostic evaluation includes laboratory tests, ultrasound of the thyroid, and fine needle aspiration if a nodule is detected. Prognostic factors like histology, stage, and tumor size help determine a patient's risk level.
- Surgical treatment typically involves total thyroidectomy. Lymph node dissection may also be performed. Postoperative radioactive iodine remnant ablation is recommended for intermediate- and high-risk
This lecture proves an overview of assessing the thyrod nodule upon presentation. The use of imaging, including nuclear medicine, PET, CT/MR and Ultrasound is discussed.
There is more detail on ultrasound evaluation with particular emphasis on ACR TIRADS
L'ecografia tiroidea: strumento cruciale nella gestione clinica?ASMaD
Presentazione a cura del Dottor Guglielmi Rinaldo - "Incontri endocrinologici AME LAzio - L'endocrinologia nel SSN: prospettive e nuove problematiche" - Roma 17/12/2018
This document provides an introduction to cancer diagnosis and treatment. It defines cancer as abnormal cells that divide uncontrollably and can invade other tissues or spread to distant areas. The document outlines the main objectives of understanding cancer including defining cancer, identifying causes and risk factors, staging malignant diseases, pathological classification, common signs and symptoms, and approaches to cancer management. It also discusses the history of cancer diagnosis and treatments throughout time.
L3- Introduction to Oncology [Autosaved].pptGaurav Jaswal
This document provides an introduction to cancer diagnosis and treatment. It defines cancer as abnormal cells that divide uncontrollably and can invade other tissues or spread to distant areas. The document outlines the main objectives of understanding cancer including defining cancer, identifying causes and risk factors, staging malignant diseases, pathological classification, common signs and symptoms, and approaches to cancer management. It also discusses the history of cancer diagnosis and treatments throughout time.
Radioactive ablation in thyriod cancersDR Saqib Shah
This document discusses radioactive iodine ablation in thyroid cancers. It provides background on the discovery of thyroid cancer, epidemiology showing it is the most common endocrine malignancy. It reviews the classification, causes, risk factors, evaluation and guidelines for treatment of differentiated thyroid cancers. It discusses the use, goals, effectiveness and factors impacting decision making for radioactive iodine remnant ablation after surgery. It also covers administration, patient preparation, dosimetry approaches and uptake differences between cancer and normal thyroid tissue.
This document presents a lexicon developed by an ACR committee to standardize the terminology used in ultrasound reports for thyroid nodules. It defines six categories used to describe sonographic features of thyroid nodules: composition, echogenicity, shape, size/dimensions, margins, and flow/Doppler. The goal is to provide evidence-based recommendations for managing thyroid nodules based on standardized terminology that can improve diagnosis and risk stratification.
Ultrasound, including Doppler ultrasound, is used to examine the thyroid gland. It can visualize the normal anatomy of the thyroid and detect any abnormalities. Doppler ultrasound provides additional information about blood flow within the thyroid and any lesions. It displays flow information using color flow mode for a qualitative overview or spectral analysis for quantitative velocity measurements. Several diseases can cause abnormalities in the thyroid that are detectable by ultrasound, such as nodules, diffuse enlargement, or malignancies.
Thyroid image reporting and data system Hisham Khatib
The document describes the Thyroid Imaging Reporting and Data System (TIRADS) for evaluating thyroid nodules found on ultrasound. TIRADS was developed in 2009 as a standardized scoring system similar to BI-RADS for breast imaging. The TIRADS system categorizes nodules from TIRADS 1 (normal) to TIRADS 6 (biopsy proven malignancy) based on ultrasound features associated with cancer risk. TIRADS 4 and 5 nodules are considered suspicious and their subcategories are determined by the number of suspicious ultrasound features present, with increasing cancer risk from 4a to 4c and 5. Features such as hypoechogenicity, microcalcifications, irregular
This case study describes the diagnosis and treatment of prostate cancer in an 87-year-old male patient. Key details include:
- Cancer was diagnosed via biopsy and confirmed to be adenocarcinoma. Staging investigations found the cancer to be localized.
- The patient underwent external beam radiotherapy to the prostate with doses of 78-79.2 Gy over 8 weeks.
- Common side effects were managed conservatively. The patient will continue follow-up care and has a good prognosis given the localized stage at diagnosis.
TIRADS is a practical system for stratifying thyroid nodule malignancy risk in clinical practice. A study of 346 nodules found substantial inter-observer agreement for TIRADS categorization. TIRADS categories 5 and 4c had high positive predictive value for malignancy, while reassigning some 4a nodules to category 3 improved specificity. Thus, TIRADS provides a simple method for ultrasound assessment and risk stratification of thyroid nodules.
1. The document discusses imaging modalities used for evaluating the thyroid gland including ultrasound, CT, MRI, nuclear scintigraphy, and recent developments.
2. Common thyroid pathologies like diffuse thyroid disease, thyroid nodules, and thyroid cancer are discussed in terms of their imaging appearance and evaluation.
3. Guidelines for evaluation and management of thyroid nodules based on sonographic features, biopsy results, and risk of malignancy are presented.
This document outlines a research study evaluating thyroid nodules using the Thyroid Imaging Reporting and Data System (TIRADS) and comparing the TIRADS classification to histopathology results. The study will involve ultrasound examination of thyroid nodules in 50 patients referred for evaluation, grading the nodules using TIRADS, and obtaining fine needle aspiration cytology or surgical resection for histopathological analysis. The TIRADS grade will then be compared to the histopathology results to assess the reliability of TIRADS in determining the nature of thyroid nodules.
By Ashik Kareem discusses thyroid cancer rates in India based on National Cancer Registry Program data from 1984-1993. Some key points:
- Thyroid cancer rates were 1 per 100,000 for males and 1.8 per 100,000 for females.
- Common risk factors include radiation exposure, especially in childhood, family history of thyroid cancer or other endocrine abnormalities, and history of familial polyposis.
- Evaluation of thyroid nodules involves physical examination, thyroid function tests, ultrasound, and fine needle aspiration biopsy (FNA). FNA is currently considered the best first-line diagnostic procedure due to its safety, low cost, minimal invasiveness, and ability to
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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2. • Thyroid nodules are highly prevalent; about one third
of the adult population has thyroid nodules on
ultrasonographic examination.
• However, less than 10% of them are malignant[1,2].
• 1. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, PanunziC, Rinaldi R, Toscano V,
PacellaCM2002 Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-
Doppler features.J Clin Endocrinol Metab 87:1941–1946
• 2. Koike E, Noguchi S, Yamashita H, Murakami T, Ohshima A, Kawamoto H,Yamashita H 2001
Ultrasonographic characteristics of thyroid nodules: predictionof malignancy. Arch Surg 136:334–337.
3. • The terminology of TIRADS was first used by Horvath
et al .
• BI-RADS was taken as a model.
• The goal was to group thyroid lesions in different
categories with a percentage of malignancy similar to
those accepted in the BI-RADS.
4. • During stage I (from 2000–2001), US findings of 362 thyroid
nodules were reviewed to define and specify their
characteristics and establish 10 US patterns –
• Echostructure.
• Echogenicity.
• Shape.
• Orientation.
• Acoustic transmission.
• Borders.
• Surface.
• Presence or absence of a capsule, calcifications, and
vascularization.
5. • At the second stage (from 2002–2003), the group
prospectively correlated the FNAB results of another
set of 500 nodules with the defined US patterns and
generated a TIRADS group classification .
6. • TIRADS 1: normal thyroid gland.
• TIRADS 2: benign conditions (0% malignancy).
• TIRADS 3: probably benign nodules (5% malignancy).
• TIRADS 4: suspicious nodules (5–80% malignancy rate).
4a (malignancy between 5 and 10%) and
4b (malignancy between 10 and 80%) .
• TIRADS 5: probably malignant nodules (malignancy >80%).
• TIRADS 6: category included biopsy proven malignant
nodules.
7. • In stage 3 (from 2003–2006), the group
prospectively validated the TIRADS evaluating
1097 additional selected nodules.
• Table shows the US characteristics for each
TIRADS group ---
8.
9. US image of multiple typical colloid cysts: anechoic areas with
hyperechogenic spots (type 1 colloid pattern).
TIRADS 2
10.
11. type 2 colloid nodule:
a mixed, nonexpansile, nonencapsulated structure with a “grid”
appearance given by isoechoic solid areas and hyperechoic
spots. The gland is not enlarged.
TIRADS 2
12.
13. colloid type 3 pattern: a mixed, nonencapsulated, expansile,
isoechoic nodule with hyperechoic spots and broad septa.
TIRADS 2
14.
15. US aspect of Hashimoto thyroiditis with a pseudo-nodule: normal size
heterogeneous gland with lobulated borders and a hyperechoic pseudo-nodule
(arrow), partially surrounded by a halo.
TIRADS 3
16.
17. US image of a simple neoplastic pattern : E -- a solid hyperechoic nodule without
calcifications, surrounded by a thin capsule.
F, A hypoechoic area with ill-defined borders, without calcifications.
TIRADS 4 A.
18.
19. US image of a suspicious neoplastic pattern (4B):
an encapsulated heterogeneous nodule with coarse calcifications,
surrounded by a thick capsule.
TIRADS 4B
20.
21. US image of malignant pattern A: TIRADS 4 B suspicious.
Solid hypoechoic, irregular nodules with ill-defined margins, with
calcifications (thin arrow) or without calcifications (thick arrow).
22.
23. US image of malignant pattern B: TIRADS 5
solid, nonencapsulated, isoechoic, ill-defined nodule with a “salt
and pepper” aspect, due to peripheral microcalcifications.
24. US image of malignant pattern C: TIRADS 6
a mixed, isoechoic, vascularized, nonencapsulated nodule with
calcifications and no hyperechoic spot.
25.
26. • FNAB is the best tool in helping to decide between nodules
that require surgery and those that can be followed.
• One of the limitations of FNAB is the indeterminate or
follicular lesion
27. • However, performing FNAB in all nodules is not cost effective;
• It is necessary to select cases according to the risk of
malignancy.
• The TIRADS classification is useful in the description of all
types of US-detected lesions, including both benign nodules
and follicular lesions.
• Patients with TIRADS 2 (benign findings) do not require FNAB.
28. • TIRAD 3 lesions should be followed; some of these patients
are biopsied when clinically warranted:
1. If the nodule grows during follow-up,
2. The patient is not able to come back for regular follow-up
checkups,
3. Patients with higher risk of malignancy -those exposed to
previous radiation to the neck,
4. Those with family history of thyroid cancer.
29. • TIRADS 4 and 5 nodules must be biopsied, and
frequently are operated on.
30. • The terminology of TIRADS was first used by Horvath et al .
• They described 10 US patterns of thyroid nodules and related
the rate of malignancy according to the pattern.
• However, these US patterns were not applicable
to all thyroid nodules and this stereotypic US application is
difficult for US performers to use.
Therefore, it is not easy to apply this kind of approach to clinical
practice.
31. • Park et al proposed an equation for predicting the probability
of malignancy in thyroid nodules on the basis of 12 US
features.
• Although this approach makes it possible to stratify nodules
into categories, it can be difficult to assign every thyroid
nodule into the equation proposed in clinical practice.
32. • Although previous investigators have tried to develop
a thyroid imaging reporting and data system
(TIRADS), the systems were difficult to apply in the
clinical field because of their complexity.
33. • The classification by Kwak et al is simple and similar
to BIRADS.
• Their aim was to develop a practical TIRADS with
which to categorize thyroid nodules and stratify their
malignant risk.
34. • Several US features, such as ---
Internal component,
Hypoechogenicity, marked hypoechogenicity,
Microlobulated or irregular margins,
Microcalcifications, and
Taller-than-wide shape,
were regarded as independent US features of
malignancy
35. • Internal component of the nodules was
classified as –
1. Solid .
2. Mixed solid.
3. Cystic.
36. • Echogenicity -
1. Hyperechogenicity,
2. Isoechogenicity,
3. Hypoechogenicity - echogenicity was less than
that of the surrounding strap muscle.
4. Marked hypoechogenicity.
37. a
<p>US scans show features indicative of malignancy, including (a) hypoechogenicity (☆ = strap muscle, arrows = nodule); (b)
38. • Margins –
1. Well circumscribed,
2. Microlobulated – the presence of many small
lobules on the surface of a nodules.
3. Irregular.
39. <p>US scans show features indicative of malignancy,
(d) irregular margin (arrows = nodule).</p>
"
40. • Calcifications -
1. Microcalcifications - equal to or less than 1
mm in diameter and visualized as tiny
punctate hyperechoic foci +/- acoustic
shadow.
2. Macrocalcifications- hyperechoic foci larger
than 1 mm.
41. <p>US scans show features indicative of malignancy, includin
microcalcifications (arrows);
42. • Shape –
1. Taller than wide (greater in its antero-posterior
dimension than in its transverse dimension).
2. Wider than tall.
43. <p>US scans show features indicative of malignancy,
(c) marked hypoechogenicity (☆ = strap muscle, arrows = nodule), microlobulated margin, and taller-than-wide shape
44. • The following US features are significantly associated with
thyroid cancer: solid component, Hypoechogenicity, marked
hypoechogenicity, microlobulated or irregular margins,
microcalcifi cations, and taller-than-wide shape.
• Nodules showing at least one of the suspicious findings were
considered suspicious for malignancy.
• As the number of suspicious US features increased, the
probability and risk of malignancy also increased.
45. • TIRADS –
• 3 (no suspicious US Features).
• 4a (one suspicious US feature),
• 4b (two suspicious US features),
• 4c (three or four suspicious US features),
• 5 (five suspicious US features).
46.
47. • Because thyroid neoplasias are slowly growing tumors , a long
follow-up period is necessary to consider a nodule as benign
in patients not undergoing thyroidectomy.
• Therefore, we may have to accept the stability of the US
findings and FNAB for a period of at least 4–5 yr as an
indicator of a benign nodule in those patients that are being
followed.
48. • The TIRADS classification and the FNAB are
complementary procedures. The TIRADS is only a
tool used to select high-risk nodules for FNAB.
• Risk stratification of thyroid malignancy by using the
number of suspicious US features allows for a
practical and convenient TIRADS.
50. • In 2009, Horvath et al proposed a classification known as TI-
RADS and later Kwak et al added a subtype (4c).
• However, not all the ultrasound features of nodules proposed
by Horvath et at can be applied with certainty in daily
practice.
• As regards Kwak et al, they did not use TN perfusion on color
Doppler within their classification.
51. • TI-RADS classification of thyroid nodules based on a score
modified according to ultrasound criteria for malignancy J.
Fernández Sánchez . Rev. Argent. Radiol. 2014;78(3): 138-148.
• This study also assessed the presence of suspicious cervical
lymph nodes (differentiating them from Kwak classification as
regards the evaluation criteria for scoring).
52. • They propose a TI-RADS classification based on a scoring
system in which each ultrasound abnormality suspicious for
malignancy is assigned a score.
• If one or more cervical lymph nodes suspicious for malignancy
are detected, an additional point is added.
53. TI-RADS classification of thyroid nodules based on a scoring system according to
ultrasound criteria for malignancy.
54. Sonographically suspicious criteria for malignancy.
Each criterion is assigned a point in the final score.
If suspicious cervical lymph nodes are detected, an
additional point is added to the score for categorizing
nodules on TI-RADS classification.
55. • In this study, 4.7% of thyroid ultrasound scans did not show
focal lesion and the thyroid gland showed a hyperechoic,
homogeneous and normal ultrasound pattern with no
changes in vascularity.
• These cases constituted category 1 in TI-RADS classification .
57. • 35.6% of TNs with well-defined criteria for benignity
(simple cyst, solid nodule with central cyst, nodule
with homogeneous peripheral calcification and
spongiform nodule), with benignity being confirmed
by various methods , were classified as TI-RADS 2.
60. • Only 2.2% of TNs with peripheral vascularity and hyperechoic (with
or without cystic changes) or diverse US pattern (hypo, iso or
hyperechoic, with cystic changes and/or macrocalcifications) proved
to be malignant.
• These TNs with a score of 1 and probably benign US findings are
classified as TI-RADS 3 (probability of malignancy < 5%) according
to Horvath et al and Kwak et al.
• In this respect, it should be noted that many of the TI-RAD 3
nodules are functioning or toxic thyroid adenomas and that
malignancy within this category is not only a rare occurrence, but
also a generally unexpected histological finding following nodular
goiter surgery .
• In our study, 9.5% of TNs meeting one criterion for malignancy were
diagnosed as thyroid carcinoma.
63. Patient with nodular goiter. In a hyperechoic nodule with small cysts, consistent
with TI-RADS 3, a small papillary thyroid carcinoma (pT1b) was histologically
detected after surgery
64. • TNs with a score of 1 were assigned category 4a in TI-RADS
classification .
• While TNs with a score of 2 were classified as TI-RADS 4b.
• In the latter case, the incidence of malignancy increased up
to 48%.
• In turn, TNs with a score of 3 or 4 showed an increased
incidence of thyroid carcinoma of up to 85%, and were
therefore included within TI-RADS 4c . In this category, Kwak
et al6 report a probability of malignancy of 50-95%.
65. Sonographically suspicious criteria for malignancy. Each
criterion is assigned a point in the final score.
If suspicious cervical lymph nodes are detected, an
additional point is added to the score for categorizing
nodules on TI-RADS classification.
67. TI-RADS 4b: nodule with microcalcifications and poorly
defined irregular margins. Score of 2.
68. TI-RADS 4b: nodule with two sonographically
suspicious criteria for malignancy:
hypoechogenicity and internal vascularity.
69. TI-RADS 4c: nodule with microcalcifications, irregular borders and taller than
wide shape (greater in its anteroposterior diameter than in its transverse
diameter). Score of 3.
70. TI-RADS 4c: hypoechoic nodule of irregular margins with a
taller than wide shape. Score of 3.
71. • TNs with a score of 5 or higher were classified as TI-
RADS 5 .
• In this study, all TNs with these ultrasound features
proved to be malignant, but Horvath et al3 and Kwak
et al6 report for this category a probability of
malignancy of 85-99%.
72. TI-RADS 5: hypoechogenic nodule with microcalcifications and poorly
defined margins, with perinodular tissue invasion (arrow). Taller than
wide shape.
73. Continued . ... TI-RADS 5: suspicious hypoechoic lymph node, with round
shape and abnormal vascularity. Overall score of 6 for the nodule.
74.
75. • Based on the criteria for malignancy and the score assigned in
this study, the probability of malignancy for TNs with a score
of 1 ( 4 A) is 10%, while for those with a score of 2 ( 4 B) is
almost 50% and for those that have been assigned a score of 3
or 4 ( 4 C) , the probability of malignancy is 85%.
• All TNs with a score of 5 or higher are malignant.
• A TI-RADS classification based on the scoring system
described above should allow for and lead to unification of
terminology and codes for TN classification among all
physicians who evaluate the results of a thyroid ultrasound .
76. • Chandramohan A, Khurana A, Pushpa B T, Manipadam MT,
Naik D, Thomas N, Abraham D, Paul MJ. Is TIRADS a practical
and accurate system for use in daily clinical practice?. Indian J
Radiol Imaging 2016;26:145-52.
77. • Of all the systems, the classification proposed by
Kwak et al. is simple and similar to BIRADS system
which has been in use for many years and is familiar
to most radiologists.
• Therefore, we aimed to assess the PPV and
inter-observer agreement of TIRADS as proposed by
Kwak et al.
78. Ultrasound features assessed for each nodule were :-
• composition (solid, cystic, mixed),
• echogenicity (hyperechoic, isoechoic, hypoechoic,
markedly hypoechoic).
• margins (well defined with or without halo sign,
microlobulated, ill-defined,irregular).
• presence of calcification (microcalcification,
macrocalcification).
• shape of the nodule (round, oval).
79. COMPOSITION –
• Nodules with >75% solid component were labelled as solid;
• Cystic nodules had no solid components .
• Mixed nodules had both solid and cystic areas with solid
component constitution <75% of the size of the lesion.
• For mixed lesions, echogenicity, margin, shape, and presence
of calcification were assessed for the solid component.
80. (A) cystic (B) solid and (C) mixed composition of thyroid nodules
81. Echogenicity was described in comparison with the thyroid gland
and the strap muscles.
• Hyperechoic if the echogenicity > that of thyroid gland.
• Isoechoic if the echogenicity = that of thyroid gland,.
• Hypoechoic if the echogenicity = that of strap muscle.
• Markedly hypoechoic if the echogenicity < than that of strap
muscle.
83. MARGINS --
• Hypoechoic smooth rim around the nodule was considered as
a positive halo sign.
• Presence of short cycle undulations of more than three along
the margin of the nodule was considered as microlobulated
margin.
• Spiculated margins were considered as irregular.
• Fuzzy margins were considered ill-defined.
85. CALCIFICATION –
• Calcification that measured less than 1 mm was
defined as microcalcification.
• Calcification more than 1 mm was labelled as
macrocalcification.
87. SHAPE –
• The shape was described as round or “taller than
wide” if the antero-posterior dimension was equal to
or greater than the transverse dimension.
• A nodule which was “wider rather than” tall was
described as an oval nodule.
88. (A) Oval and (B) taller than wide shaped thyroid nodules
89. Findings that were considered in favor of a malignancy
were –
• Hypoechoic or markedly hypoechoic in echogenicity;
• Irregular, mcrolobulated or ill-defined margins.
• Presence of microcalcification;
• Round shape.
90. • Completely cystic thyroid nodule, nodules with comet tail
artifacts, and spongiform thyroid nodules ----TIRADS
category 2.
• Solid, oval, well-defined, isoechoic nodules ---- TIRADS
category 3.
• Nodules were assigned TIRADS categories 4a, 4b, 4c, and 5
if they had one, two, three, and more than three suspicious
ultrasound features, respectively.
• Presence and absence of significant neck nodes
(hypoechoic, round nodes with calcification or necrosis
irrespective of their size) and the pattern of vascularity of
the nodules were also documented, though they were not
a part of TIRADS.
91.
92. Comparison of diagnostic performance of the various ultrasound classification systems
available to assess thyroid nodules
93. • There was improvement in the PPV (from 64% to 75%) and
specificity (from 69% to 85.5%) when TIRADS category 4a
nodules were reassigned to category 3;
• However, sensitivity of TIRADS reduced (from 72% to 60%).
• In the actual clinical setting, it may be practical to follow-up
patients with just one suspicious feature and indeterminate
cytology than subjecting them to surgery.
94. • Of the 112 malignant thyroid nodules, 34 (30.3%) were a
follicular variant of papillary cancers which have a relatively
benign ultrasound appearance.
• In conclusion, the PPV for malignancy was high for TIRADS
category 5 and 4c nodules.
• Reassigning TIRADS category 4a nodules as TIRADS 3 will
improve the PPV and specificity of TIRADS.
• Overall agreement between observers for assigning TIRADS
category was substantial.
• Thus, TIRADS is a simple and practical method of assessing
thyroid nodules and can be used in practice.
96. • Correlation of Thyroid Imaging Reporting and Data System [TI-RADS] and
fine needle aspiration: experience in 1,000 nodules;einstein.
2016;14(2):119-23,Rahal Junior A, Falsarella PM,Rocha RD, Lima JP, Iani
MJ, Vieira FA, Queiroz MR, Hidal JT, Francisco Neto MJ, Garcia RG, Funari
MB.
97. • The TI-RADS classification aims to correlate US features to
cytological classification, increasingly graduating the risk of a
nodule being malignant, according to the number of features
present in the US.
• Among diverse classifications, Horvath et al , by means of a
prospective analysis, proposed ten US patterns to be analyzed
during the examination and nodule classification from TI-RADS 2 to
6 (category 4 divided into 4A and 4B) and estimated a malignancy
risk of 14.1% in TI-RADS 3, 45% in TI-RADS 4, and 89.6% in TI-RADS
6.
• Kwak et al. proposed a TI-RADS classification through retrospective
analysis of patients submitted to thyroid US and FNA, considering
the risk of malignancy and subdivisions similar to the BI-RADS
classification (that is, with three subdivisions for category 4), using
five US criteria that can be added during thyroid evaluation.
98. • A significant association was found between the TI-RADS outcome and
Bethesda classification (p<0.001).
• Most individuals with TI-RADS 2 or 3 had Bethesda 2 result (95.5% and
92.5%, respectively).
• Among those classified as TI-RADS 4C and 5, most presented Bethesda 6
(68.2% and 91.3%, respectively; p<0.001).
• The proportion of malignancies among
• TI-RADS 2 was 0.8%, and TI-RADS 3 was 1.7%.
• TI-RADS 4A -----16.0%,
• 4B -------- 43.2% .
• 4C -------72.7%
• 91.3% among TI-RADS 5 (p<0.001),
• Showing clear association between TI-RADS and biopsy results.
Conclusion:
• The TI-RADS is appropriate to assess thyroid nodules and avoid
unnecessary fine needle aspiration, as well as to assist in making decision
about when this procedure should be performed.
99. • This article also described that a malignancy risk lower than
3% is expected for TI-RADS 3, a risk of 3.6 to 91.9% for TI-
RADS 4, and of 88.7 to 97.9% for TI-RADS 5.
100. • The present study has differences in relation to that proposed by Horvath
et al. such as being retrospective and with one more subdivision in the
category 4, by adding 4C.
• Besides our purpose was to facilitate the classification process, reducing
from ten to only four features in B-mode US considered in our
classification.
• It also differed from the study by Kwak et al. in this issue, since these
authors used five features in the classification, one more than ours.
• This difference relied on the nodule composition, that we judged as liable
to mistakes in some cases, since many mixed nodules could generate
uncertainty about their precise composition in ultrasonographic
evaluation.
• Instead, we considered two points of marked hypoechogenicity, because
the nodules with such characteristics have an increased risk of malignancy
as compared to those slightly hypoechoic.
101. The Bethesda System for Reporting Thyroid Cytopathology
Category Meaning
I Non-diagnostic or inadequate
II Benign
III Atypia/follicular lesion of undetermined significance
IV Follicular neoplasm or suspicious for follicular
neoplasm
V Suspicious for malignancy
VI Malignant
Source: Cibas et al.
Editor's Notes
several nodules in the same gland with a similar ultrasound pattern: hyper or isoechoic nodules, with small cystic changes and small hypoechoic spots, as well as microcalcifications (arrow) and peripheral perfusion. In the thyroid scintigraphy (lower row on the right) TNs appear as toxic adenomas in a patient with hyperthyroidism.
Patient with nodular goiter. In a hyperechoic nodule with small cysts, consistent with TI-RADS 3, a small papillary thyroid carcinoma (pT1b) was histologically detected after surgery