Background: Thyroid ultrasound(US) is used as the first diagnostic tool to assess the management of disease butis operator dependent. There have been few reports evaluating interrater variability in US assessment. Therefore, weevaluated interrater reliability in US assessment of thyroid nodules and estimated its diagnostic accuracy for variousTIRADS systems. Methods: This retrospective study included 24 malignant nodules and 84 benign nodules fromJanuary 2015 to October 2017. Two blinded observers independently reviewed stored US images by using TIRADS. Allanalyses followed guidelines proposed by ACR-TR, Siriraj-TR and EU-TR systems. Interrater reliability was calculatedusing Cohen’s Kappa statistics. Diagnostic accuracy were also calculated. Results: Interobserver agreement showedsubstantial agreement for composition (K=0.616); echogenicity and echogenic foci showed fair agreement (K=0.327and 0.288, respectively); margin showed slight agreement (K=0.143). Interrater reliability for the final assessment;moderate agreement for ACR-TIRADS system (K=0.500); fair agreement for EU-TIRADS system (K=0.209) andslight agreement (K=0.114) for Siriraj-TIRADS system. The diagnostic performance from the two observers; ACRTIRADSsystem; sensitivities were 75% and 79.2%, specificities were 58.3% and 56%, positive predictive value (PPV)were 34% and 33.9% and negative predictive value (NPV) were 89.1% and 90.4%. For the Siriraj-TIRADS system,sensitivities were 41.7% and 25%, specificities were 84.5% and 89.3%, positive predictive value (PPV) were 43.5%and 40% and negative predictive value (NPV) were 83.5% and 80.6%. For the EU-TIRADS system, sensitivities were45.8% and 66.7%, specificities were 79.8% and 72.6%, positive predictive value (PPV) were 39.3% and 41% andnegative predictive value (NPV) were 83.8% and 88.4%. Conclusion: The ACR-TIRADS had highest interobserveragreement, a trend to have highest sensitivity and negative predictive value for diagnosis of malignant thyroid nodules.Siriraj-TIRADS had higher specificity and accuracy, but

Background: To compare diagnostic accuracy between DWI visual scale assessment and ADC value measurement of solid portion of the tumor in grading gliomas. Methods: This retrospective study included 38 patients who had pathologically proven gliomas between January 2013 and August 2018 with 18 low grade and 20 high grade tumors. All patients underwent MRI and biopsy. Two readers reviewed DWI visual scale independently. Disagreement was resolved by consensus. One reviewer measured ADC value of entire solid part of the tumor in single axial slice with greatest dimension of tumor which was chosen by consensus. Two data sets of visual scale and ADC value were analyzed and comparison of diagnostic accuracy in glioma grading was done by using area under the curve (AUC) of receiver operating characteristic curve (ROC). Results: Visual scale and ADC value could be used to distinguish between low and high grade gliomas with a statistically significant difference. (P-value 0.002 and <0.001). Almost all high grade gliomas had visual scale 5. The sensitivity, specificity, PPV NPV and accuracy were 50%, 100%, 100% , 64.3%,73.68% respectively. The cutoff level for the ADC value was determined to be 1119.48 x10-6 mm2/s in differentiation between low and high grade gliomas with the sensitivity, specificity, PPV, NPV, accuracy of 90%, 88.89% , 90%, 88.9% and 89.47% respectively. There was no statistically significant difference(P-value = 0.163). Conclusion: Both Visual scale and ADC value were capable of differentiating between low and high grade gliomas. Although visual scale may not replace ADC measurement, larger scale prospective study is needed for validate this initial result.

Intramedullary tuberculoma (IMT) of the conus medullaris is extremely rare. We present a case of intramedullary conus medullaris tuberculoma in which the diagnosis was based on there being very high levels of adenosine deaminase (ADA) in the patient’s cerebrospinal fluid (CSF) and improvement with antituberculous therapy. A 78-year-old man presented after having had a dull ache in both thighs and progressive paraparesis. The patient’s medical history included diffuse large B-cell lymphoma, which had undergone remission due to chemotherapy two years earlier, and long-term, well-controlled diabetes. A chest X-ray showed no evidence of tuberculosis. The results of CSF analysis were compatible with Froin’s syndrome. An initial diagnosis was made of an intramedullary tumor of the conus medullaris, based on magnetic resonance imaging (MRI). A myelotomy and multiple punch out biopsy were performed, and histopathology of the tissues revealed mild reactive gliosis. Due to the patient having high levels of CSF-ADA, IMT of the conus medullaris was suspected. The patient was treated with an 18-month course of antituberculous therapy. The dull ache gradually disappeared, and motor power improved slightly. A follow-up MRI of the lumbosacral (LS) spine revealed that the lesion had completely disappeared. Intramedullary tuberculoma of the conus medullaris should be considered in patients with underlying malignancy and no symptoms of systemic tuberculosis. CSF adenosine deaminase levels can be helpful in determining the presence of central nervous system tuberculosis when other systemic signs of disease are lacking.

Spinal sparganosis of the cauda equina has been rarely reported. A 54-year-old man presented at the hospital after having experienced lower back pain for 10 months, progressive weakness and numbness of the left leg for 4 months, and urinary incontinence for 3 weeks. Magnetic resonance imaging of the lumbosacral spine revealed a heterogeneous enhancing mass at the T12-S1 level. Spinal sparganosis was diagnosed by histological examination and molecular identification of the parasite in the tissue section. The patient was treated with a high dose of praziquantel because the parasitic mass was only partially removed and symptoms worsened following surgery.

Background Temporal bone computed tomography (CT) is essential for evaluating ear diseases but requires awareness of normal variations to avoid misdiagnosis. The cochlear cleft, seen as pericochlear CT hypoattenuation, reflects incomplete endochondral ossification and mainly occurs in children. Although a normal variant, it can mimic conditions such as otosclerosis. Data on its prevalence and extent in children, especially in relation to hearing status and other temporal bone findings, remain limited. Objective The aim of our study is to evaluate the overall prevalence of cochlear clefts in children and to determine their clinical significance. Materials and methods A total of 404 temporal bone CTs without pathologies were reviewed retrospectively by two neuroradiologists. The prevalence and the extent (mild, moderate, or extensive) of pericochlear CT hypoattenuation, representing the cochlear cleft, were recorded, and their correlation with clinical findings was evaluated. Results Among 404 CTs examined, cochlear clefts were observed in 135 cases (33.4%). The presence of cochlear clefts was independently associated with a younger age group (0–4 years old, P-value <0.001), but not with other parameters such as sex, hearing loss status, inner ear anomalies, or other temporal bone pathologies. Conclusion Cochlear clefts are an anatomical variation that is prevalently associated with younger age. Thus, pericochlear CT hypoattenuation in young children should be interpreted with caution, as it can be caused either by cochlear clefts (an anatomical variation) or by pathologies. Radiologists should be aware of and recognize cochlear clefts to avoid unnecessary medical or surgical interventions. Graphical Abstract