Maya Cohen

Effect of Aging on the Adult Extrahepatic Bile Duct A Sonographic Study

Objective. To determine whether the size of the extrahepatic bile duct increases with age in adults. Methods. We prospectively collected data on 251 patients aged 20 years or older who underwent abdominal sonography. None of the patients had a history of liver, gallbladder, biliary, or pancreatic disease or surgery. The extrahepatic bile duct was measured at 3 locations: in the porta hepatis, in the most distal aspect of the head of the pancreas, and midway between these points. Least squares linear regression was used to correlate patient age and the size of the extrahepatic bile duct. Results. There were 126 men and 125 women aged 20 to 94 years (mean ± SD, 52.5 ± 17.63 years). Twelve percent of the study population were younger than 30 years, and 12% were older than 80 years. The mean diameters of the common bile duct in the 3 locations were as follows: proximal, 3.39 ± 1.14 mm; middle, 3.72 ± 1.28 mm; and distal, 4.28 ± 1.18 mm. The overall mean for all measures was 3.66 ± 1.15 mm. The width of the common bile duct ranged from 1.0 to 8.6 mm. There was a significant correlation between common bile duct size and age (r = 0.535; P < .001). Mean common bile duct sizes were 3.128 ± 0.862 mm in the patients younger than 50 years and 4.19 ± 1.15 mm in the patients older than 50 years (P < .001 by independent t test for equality of means). We have found that the duct gradually dilated 0.04 mm/y. Conclusions. This study revealed an age‐dependent change in the diameter of the extrahepatic bile duct. We suggest that the upper normal limit of the duct in elderly persons be set at 8.5 mm.

Pediatric Thyroid Cancer: Postoperative Classifications and Response to Initial Therapy as Prognostic Factors

CONTEXTnPrognostic factors for pediatric differentiated thyroid cancer (DTC) are not well established.nnnOBJECTIVEnThe objective of the study was to retrospectively compare the postoperative risk-stratification systems: American Thyroid Association (ATA) risk categories, Schneider Childrens Medical Center of Israel (SCMCI) score, and the response to initial therapy as predictors for disease outcome.nnnPATIENTS AND METHODSnFifty-four DTC patients, median age at diagnosis 13.9 years (range 1.9-17 y), followed up for a median of 8.8 years (range 2.6-20.5 y) were stratified into prepubertal (n = 9), pubertal (n = 25), and postpubertal (n = 20) groups. All patients underwent total/near-total thyroidectomy; 48 received radioiodine therapy. The extent of DTC was evaluated by applying the ATA risk categories and the novel SCMCI score. Postoperative risk stratifications (low/intermediate/high) were determined using histopathological, laboratory, and imaging findings. Response to initial therapy (complete/acceptable/incomplete) was based on stimulated thyroglobulin and imaging results during the first 2 years of follow-up.nnnRESULTSnThe risk for recurrent/persistent disease, as assessed by the postoperative ATA risk-stratification system and the SCMCI score and by the response to initial therapy, was higher in the prepubertal group (P < .001, P = .002, and P = .02, respectively). Outcome prediction by the risk-stratification systems was applicable: ATA risk categories, P = .014, R(2) = 0.247, predictive ability 80.4%; SCMCI score, P < .001, R(2) = 0.435, predictive ability 86.3%; and response to initial therapy stratification, P < .001, R(2) = 0.789, predictive ability 96.1%. The proportion of variance explained by the ATA risk categories (0.25), SCMCI score (0.44), and response to initial therapy (0.79) indicated that the latter was the most precise predictor and that the SCMCI score reflected the disease outcome better than ATA risk categories.nnnCONCLUSIONSnOur data confirm that the postoperative pediatric ATA stratification system and the novel SCMCI score are suitable for predicting the risk of recurrent/persistent disease in this population. The response to initial therapy classification performed 1-2 years after the initial therapy may be more appropriate for guiding surveillance recommendations.

Size discrepancy between sonographic and pathological evaluation of solitary papillary thyroid carcinoma

BACKGROUNDnSonographic size of suspicious thyroid lesions is an essential parameter in the evaluation of thyroid nodules, determining the need for needle biopsy and has impact on the extent of surgery. Limited data is available on the correlation between the size of the thyroid nodule on sonography and the actual size measured during histological examination. The aim of the present study was to compare these two modalities and to discuss the potential clinical implications of the findings in the study population.nnnMETHODSnThe database of Rabin Medical Center was reviewed for all patients with histologically proven papillary carcinoma of the thyroid treated by thyroid surgery between 2005 and 2010.nnnRESULTSn292 patients with papillary thyroid carcinoma were included. The mean sonographic size of the nodule was 2.19 ± 1.15 cm. The mean pathological diameter was 1.69 ± 1.09 cm. Discrepancies between tumor histological diameter and the sonographically measurement were more prominent in tumors larger than 1.5 cm. Nonetheless, 18.8% of thyroid nodules that were measured by US as larger than 1cm, were found to be smaller than 1cm on final pathology. Similarly, 7.2% of nodules evaluated by sonography were determined as being larger than 4 cm, while their definitive size was smaller than 4 cm.nnnCONCLUSIONSnWe noted a significant discrepancy between the preoperative sonographic and the pathologic size measurements for papillary thyroid carcinoma. The sonographic evaluation misclassifies both patients with small and large thyroid tumors, and consequently exposes them to unnecessary workup and more extensive operation. This discrepancy between the ultrasound findings and actual tumor size should be taken into account in clinical practice and help guide the evaluation and treatment of patients with thyroid nodules.

Value of ultrasound in detecting central compartment lymph node metastases in differentiated thyroid carcinoma

AbstractThe value of ultrasound in detecting central compartment lymph node metastasis in patients with well-differentiated thyroid carcinoma (WDTC) is unclear. Prospective patients with WDTC attending a university-affiliated tertiary medical center between July 2010 and June 2011 underwent neck ultrasound for detection of central compartment lymph node metastases prior to surgery. Central lymph node dissection was performed during the initial surgery regardless of ultrasound findings. The sensitivity and specificity of preoperative ultrasound in detecting central lymph node metastases were calculated according to the final histopathological results. Sixty-four patients met the study criteria. Twenty-four had pathologic central compartment lymph nodes according to preoperative ultrasound, 20 of which were confirmed by histological examination. One patient was found to have pathological central lymph nodes by histology which was not detected by US. Sensitivity of preoperative ultrasound was 95xa0%, specificity 90xa0%, and negative and positive predictive values 97 and 83xa0%, respectively. Preoperative ultrasound may serve as an accurate and important tool for deciding the extent of surgery in WDTC.n

High incidence of silent cerebral infarcts in adult patients with beta thalassemia major

OBJECTIVESnSurvival of beta thalassemia major (TM) patients has improved significantly over the past few decades. Consequently, less commonly reported complications are now being recognized. An incidence as high as 60% of silent cerebral infarcts (SCI) has been demonstrated by brain Magnetic Resonance Imaging (MRI) studies in beta thalassemia intermedia (TI). The aim of this study was to determine whether regularly transfused TM adult patients experience less SCI, as compared to the incidence described in TI.nnnMETHODSnIn this observational study, 28 transfusion dependent TM patients, >18years of age underwent brain MRI studies.nnnRESULTSnFocal bright foci in the cerebral white matter were demonstrated in 17 (60.7%) patients; most of them had multiple lesions. Elevated serum ferritin (SF), primarily 5years Area Under the Curve, was found to have a significant association with the presence of SCI (p<0.031). Similar results were found when 4 patients with intact spleen and 2 patients with splenules were excluded (p=0.027). There was no significant association between number of SCI and clinical or other laboratory parameter evaluated.nnnCONCLUSIONSnThe present study demonstrates a high rate of SCI in regularly transfused TM adult patients. Effective continuous iron chelation, preventive low dose aspirin and routine periodical brain MRI are recommended.

Invasive Lobular Carcinoma of the Breast: Appearance on Digital Breast Tomosynthesis

Background: The aim of this study was to characterize the signs of invasive lobular carcinoma of the breast on digital breast tomosynthesis (DBT) imaging. Patients and Methods: The study group included 23 women with pathologically proven invasive lobular carcinoma of the breast for whom both digital mammography (DM) and DBT images were available. The images were read jointly by 2 experienced breast radiologists. Findings were recorded according to the descriptors in the Breast Imaging and Reporting Data System lexicon and correlated with the detailed pathology results. Results: In 21 of the 23 patients, the combination of DM and DBT yielded pathologic findings (91%). Architectural distortions or spiculations were demonstrated in 87% of cases. The addition of DBT to DM improved lesion detection by more clearly depicting both the lesion margins and architectural distortions. Only 2 lesions were occult by both DM and DBT, including 1 lesion in a peripheral location that was not incorporated in the standard mediolateral oblique and craniocaudal views. Conclusion: DBT improves the detection of invasive lobular carcinoma lesions by more clearly depicting architectural distortions and spiculations.

Ultrasonography in patients without trauma in the emergency department: impact on discharge diagnosis.

The aim of this study was to examine to what extent findings on ultrasonography performed in the emergency department (ED) after hours confirm or alter the referral diagnosis in patients without trauma as reflected in the discharge diagnosis.

Evaluation of renal angiomyolipoma by traditional and modern imaging in a case of tuberous sclerosis

Renal angiomyolipoma is known to affect mainly patients with tuberous sclerosis, although it can be found in a significant number of otherwise normal individuals. Few cases have been published in which angiomyolipoma and renal cell carcinoma occurred in the same kidney. In such cases the radiologist may be asked if it is possible to distinguish between the two tumors in the same kidney. The present case report describes systemic traditional and modern imaging of huge bilateral angiomyolipoma in tuberous sclerosis. The analysis of the data implies that, although the diagnosis of angiomyolipoma can be established with noninvasive techniques only, it is impossible to distinguish between the two mentioned tumors if they coexist in the same kidney, even if all available imaging techniques are used.

Accuracy of Neck Ultrasonography in Predicting the Size and Location of Parathyroid Adenomas

Objectives Ultrasonography (US) is a reliable tool for the preoperative localization of parathyroid adenomas (PTAs). The aim of this study was to evaluate the accuracy of US for estimating both the size and the location of PTAs and the effect of operator expertise. Study Design Retrospective cohort study. Setting A single tertiary medical center. Subjects and Methods All patients who underwent parathyroidectomy for primary hyperparathyroidism between 1996 and 2012 were included. The estimated PTA localization and size by preoperative ultrasound were compared with the intraoperative findings and pathology report. Results The cohort included 410 patients. US correctly localized the adenoma in 76% of cases with a sensitivity of 76.2% and a positive predictive value of 86.8%. Measurements were least accurate for adenomas measuring <1 cm in diameter (24%). Scans made by a single senior operator specializing in the neck had a higher accuracy rate than scans made by multiple operators, with a significant difference for small adenomas (P < .001). Conclusions US is an accurate and sensitive tool for evaluating PTA size and location. Neck US is less accurate for small adenomas (<1 cm). In these cases particularly, the experience and expertise of the US operator may play an important role.

Analysis of false-negative readings of automated breast ultrasound studies

To assess the reasons for false‐negative readings of automated breast ultrasound (ABUS) studies.