Initial experience of 3 tesla apparent diffusion coefficient values in differentiating benign and malignant thyroid nodules

Purpose:

To evaluate the role of diffusion‐weighted magnetic resonance imaging (DWMRI) in differentiating benign and malignant thyroid nodules using a 3 Tesla (T) MRI scanner.

Materials and Methods:

Twenty‐eight nodules in 25 patients and 14 healthy control cases were included in the study. DWMRI was acquired with 6 b values with a 3T MRI scanner. The apparent diffusion coefficient (ADC) values of the nodules were calculated from reconstructed ADC map images and were compared with the final histopathological diagnoses.

Results:

The mean ADC value of the benign nodules was 1548 ± 353.4 (×10^?6 mm²/s), and the mean ADC of the malignant nodules was 814 ± 177.12 (×10^?6 mm²/s). The normal thyroid tissue had a mean ADC value of 1323.43 ± 210.35 × 10^?6 mm²/s (958–1689 × 10^?6 mm²/s) in the healthy control group. The ADC values were significantly different among the three groups (P = 0.001). An ADC value of 905 × 10^?6 mm²/s was determined to be the cutoff value for differentiating benign and malignant nodules, with 90% (55.5–98.3) sensitivity and 100% (81.3–100.0) specificity.

Conclusion:

This study suggests that the ADC values of nodules measured with a 3T MRI scanner could help in differentiating benign thyroid nodules from malignant nodules. J. Magn. Reson. Imaging 2013;37:1077–1082. © 2012 Wiley Periodicals, Inc.

     

Impact of laryngeal findings on acoustic parameters of patients with laryngopharyngeal reflux

Objectives: To identify the effects of laryngopharyngeal reflux (LPR)-related laryngeal findings on objective voice parameters. Methods: Two hundred and thirty patients clinically diagnosed as having LPR and 48 healthy controls were included. The reflux finding score was determined for each subject via videolaryngoscopy. The acoustic parameters evaluated were jitter, shimmer, noise-to-harmonic ratio and Voice Turbulence Index (VTI). Results: Shimmer and VTI showed statistically significant differences between the LPR and control groups among males (p < 0.05). For females, all of the 4 acoustic voice parameters were significantly different between the two groups (p < 0.05). Erythema/hyperemia was found to affect the highest number of voice parameters. VTI was found to be affected by the highest number of laryngeal findings. Conclusion: Objective voice changes were documented in LPR patients, with VTI being the most affected parameter, and therefore it should be considered in the acoustic analysis of patients with LPR in addition to the conventional parameters. With hyperemia in the first rank, ventricular obliteration, pseudosulcus and vocal fold edema are found to have an impact on voice, suggesting that these should be concentrated on in the diagnosis and follow-up of LPR patients with voice disorders.     

Vascular Parkinsonism: a case of lacunar infarction localized to mesencephalic substantia nigra

An 80-year-old caucasian man with acute onset parkinsonism is reported here. Lower limbs were predominantly involved and he did not show remarkable improvement with dopaminergic therapy. His MRI investigation showed an isolated lesion on the right side of the mesencephalon, consistent the localization of substantia nigra. The association of acute onset parkinsonism and this radiological finding is very rare in the literature.     

Dietary vitamin A intake and serum retinol concentrations of preschool children from different socio-economical levels in Izmir, Turkey

Aim: Vitamin A deficiency (VAD), especially in its subclinical form, is a world health problem in young children. The aim of this study was to determine the prevalence of VAD among preschool children in various socio‐economic groups in ?zmir, Turkey. Methods: One hundred and one children aged 24–59 months were selected for the study with cluster sampling method. A questionnaire was completed by the parents, and the dietary pattern was assessed by using a 3‐day dietary record method. Results: Mean serum retinol concentration of the children was 28.3 ± 10.2 μg/dL. Serum vitamin A concentration of two children (2%) was below 10 μg/dL (VAD), whereas 18 (18%) children had vitamin A concentrations between 10 and 20 μg/dL (subclinical deficiency). We did not find any relationship between mean serum retinol concentrations and the independent variables such as socio‐economical levels, age groups, birth weight and gestational age. However, there was a statistically significant positive correlation between serum retinol concentrations and weight‐for‐age and weight‐for‐height Z scores of the children (p < 0.05). Conclusion: Because one‐fifth of the children under 5 years have VAD in ?zmir, Turkey, nutrition education must be given to the families during well‐child care visits, and routine vitamin supplementation should be considered especially in children with malnutrition.     

Influence of rocuronium on achieving optimal vagal stimulation during intraoperative nerve monitoring in thyroid surgery

BackgroundIn the present study we determine the feasibility of intraoperative neuromonitoring following the administration of a nondepolarizing neuromuscular blocking agent during thyroid operations, as well as the influence of rocuronium on the achievement of optimal vagal stimulation during intraoperative neuromonitoring in thyroid surgery. We further investigate whether accelerometry is a reliable approach to obtaining an ipsilateral vagus signal prior to recurrent laryngeal nerve dissection.MethodsIncluded in the study were 61 thyroidectomized patients whose demographic data, indications, type of surgery, vagus, and recurrent nerve values before and after resection were obtained. We created five groups of patients based on the twitch values recorded during ipsilateral vagus stimulation prior to the recurrent laryngeal nerve dissection: (1) <10%, (2) 11–25%, (3) 26–50%, (4) 51–75% and (5) >75%.ResultsThe average electromyography amplitudes of the vagus nerve prior to the determination of the recurrent laryngeal nerve for each group were 552 μV, 463 μV, 543 μV, 513 μV and 551 μV, respectively. No difference between the groups was observed in this regard (p > 0.05).ConclusionIt can be expected that as soon as the effects of neuromuscular blockers on the peripheral muscles begin to abate, it will be possible to obtain the ipsilateral vagus signal prior to recurrent laryngeal nerve dissection at the desired levels. It can be concluded from this study that accelerometry using the pollicis muscle is an unreliable tool for the interpretation of the proper electromyography signals of the vagus nerve prior to the determination of the recurrent laryngeal nerve.