Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Aug 2021
ReviewImaging of Cervical Lymph Nodes in Thyroid Cancer: Ultrasound and Computed Tomography.
Sonographic evaluation of cervical lymph nodes in patients with thyroid malignancy is important both for preoperative staging and for post-treatment surveillance, and contrast-enhanced computed tomography plays a complementary role. Knowledge of anatomy and surgical approaches, combined with an understanding of the various imaging features that distinguish malignant from benign lymph nodes, allows for accurate staging, thereby enabling complete surgical initial resection.
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Neuroimaging Clin. N. Am. · Aug 2021
ReviewParathyroid Imaging: Four-dimensional Computed Tomography, Sestamibi, and Ultrasonography.
Primary hyperparathyroidism results most commonly from a parathyroid adenoma, a benign parathyroid tumor that causes high levels of parathyroid hormone production. Given recent advances in surgical techniques allowing more focused, minimally invasive procedures, presurgical identification of candidate operative tissue has become increasingly useful in avoidance of 4-gland exploration. ⋯ This article discusses technical and interpretive approaches for the available modalities, and reviews their strengths and weaknesses. Updates to the individual modalities and approaches for problem solving in lesion detection are also addressed.
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Neuroimaging Clin. N. Am. · Aug 2021
ReviewPreoperative Molecular Testing of Thyroid Nodules: Current Concepts.
Robust molecular testing is commercially available for adjuvant assessment of cytologically indeterminate thyroid nodules. Testing has been developed and optimized for fine needle aspiration biopsy collections of thyroid nodules typically under ultrasound evaluation. These assays use a combination of gene expression and/or DNA and RNA assessments for molecular alterations to stratify indeterminate thyroid nodules as benign with risk level similar to benign cytologic read or suspicious with increased risk of malignancy. Guidelines for when to consider adjuvant molecular testing will be discussed.
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Surgical intervention remains the mainstay of treatment of hyperparathyroidism and provides the highest chance at cure. After the disease is confirmed by biochemical testing, surgeons must use a combination of patient clinical history and radiographic imaging to determine the most appropriate surgical strategy. Through either minimally invasive parathyroidectomy or bilateral cervical exploration, surgeons provide high rates of cure for hyperparathyroidism with low rates of persistence or recurrence.
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Neuroimaging Clin. N. Am. · Aug 2021
ReviewUltrasound of Thyroid Nodules and the Thyroid Imaging Reporting and Data System.
Benign or malignant thyroid nodules are common in adults. Fine needle aspiration biopsy is the gold standard for diagnosis. Most thyroid nodules are benign. ⋯ The American College of Radiology Thyroid Imaging Reporting and Data System committee published a standardized approach to classifying nodules on ultrasound. The ultrasound features in this system are categorized as benign, minimally suspicious, moderately suspicious, or highly suspicious for malignancy. Applying the Thyroid Imaging Reporting and Data System results in a meaningful decrease in the number of thyroid nodules biopsied.