Ziel: Die Ultraschalluntersuchung des Halsbereichs erkennt eine große Anzahl von nicht tastbaren Schilddrüsenknoten in der Patientenpopulation, aber sie bietet eine unzureichende diagnostische Sicherheit (der Nachweis von Mikrokalzifikationen stellt das einzige statistisch signifikante Malignitätskriterium dar). Das Ziel dieser Studie war die Beurteilung der Elastosonografie, einer Technik, die durch die Bestimmung der Härte eine Unterscheidung zwischen pathologischem und normalem Gewebe ermöglicht und sich auch bei der Charakterisierung von Schilddrüsenknoten als hilfreich erweisen könnte. Material und Methoden: In dieser prospektiven Studie wurden 51 Schilddrüsenknoten in 40 aufeinanderfolgenden Patienten untersucht (25 Frauen, 15 Männer, mittleres Alter ± SD, 54 ± 13,4). Die Elastosonografie wurde in Echtzeit mit Freihandtechnik durchgeführt mit einem Logos-HiVision-Gerät mit 10 MHz-Schallkopf, und die Veränderungen wurden klassifiziert und eingeteilt in 4 Härtegrade. Alle Patienten wurden auch mit der hochfrequenten Grauwertsonografie sowie Farbdoppler untersucht. Die endgültigen Diagnosen wurden aufgrund der zytologischen und/oder histologischen Beurteilung gestellt. Ergebnisse: Die endgültigen Diagnosen lauteten 11 maligne und 40 benigne Knoten. Nur in zwei Fällen zeigte der Ultraschall Veränderungen auf, die für eine Differenzialdiagnose hilfreich waren (Mikrokalizifikationen im Inneren der Knoten). Die korrekte Differenzierung zwischen malignen und benignen Knoten gelang mittels der Elastosonografie in 43 / 51 Fällen mit 5 falsch positiven (FP) und 3 falsch negativen (FN) Ergebnissen. Spezifität, Sensitivität und Treffsicherheit lagen jeweils bei 87,5 %, 81,8 % und 86,2 %. Der negative Vorhersagewert (PNV) und positive Vorhersagewert (PPV) lagen bei 94,5 % und 64 % die area under the curve (AUC) bei 0,86. Schlussfolgerung: Die Elastosonografie leistet einen interessanten Beitrag zur Differenzierung von malignen und benignen Schilddrüsenknoten. Besonders zu erwähnen ist, dass ein völlig elastisches Knotenmuster nur in Verbindung mit benignen Knoten beobachtet wurde. Dieses Ergebnis lässt erwarten, dass sich hierdurch der sofortige Griff zu Feinnadelpunktion vermeiden lassen könnte. Purpose: Ultrasound of the neck detects a large number of non-palpable thyroid nodules in the population, but it offers poor diagnostic accuracy (the presence of microcalcifications is the only statistically significant criterion indicative of malignancy). The aim of this study is to evaluate elastography, a technique which allows differentiation between pathological and normal tissue by determining its hardness and which could also prove useful in the characterisation of thyroid nodules. Materials and Methods: In this prospective study, 51 thyroid nodules in 40 consecutive patients were examined (25 women, 15 men, mean age ± SD, 54 ± 13.4). Elastosonography was performed by real-time, free-hand technique, using Logos HiVision equipment with a 10 MHz transducer and lesions were classified and scored in 4 classes of hardness. All patients were also examined by grey scale high frequency ultrasound and colour Doppler. Final diagnoses were obtained from cytological and/or histological evaluation. Results: Final diagnoses revealed 11 malignant and 40 benign nodules. Only in two cases ultrasound demonstrated signs useful for a differential diagnosis (intrinsic microcalcifications). Correct differentiation of malignant from benign nodules was obtained by elastosonography in 43 / 51 cases with 5 false positives (FP) and 3 false negatives (FN). Specificity, sensitivity and accuracy were 87.5 %, 81.8 % and 86.2 %, respectively. Predictive negative value (PNV) and predictive positive value (PPV) were 94.5 % and 64 % area under the curve (AUC) 0.86. Conclusion: Elastosonography provides an interesting contribution to the differentiation of malignant and benign thyroid nodules. Particularly worthy of mention is that an entirely elastic nodule pattern was observed only in relation to benign nodules, a result which would suggest that immediate recourse to FNAB might be avoided.

Background and objective: Dysferlinopathies are a group of muscle disorders caused by mutations in the DYSF gene. Previous muscle imaging studies describe a selective pattern of muscle involvement in smaller patient cohorts, but a large imaging study across the entire spectrum of the dysferlinopathies had not been performed and previous imaging findings were not correlated with functional tests.Methods: We present cross-sectional T1-weighted muscle MRI data from 182 patients with genetically confirmed dysferlinopathies. We have analysed the pattern of muscles involved in the disease using hierarchical analysis and presented it as heatmaps. Results of the MRI scans have been correlated with relevant functional tests for each region of the body analysed.Results: In 181 of the 182 patients scanned, we observed muscle pathology on T1-weighted images, with the gastrocnemius medialis and the soleus being the most commonly affected muscles. A similar pattern of involvement was identified in most patients regardless of their clinical presentation. Increased muscle pathology on MRI correlated positively with disease duration and functional impairment.Conclusions: The information generated by this study is of high diagnostic value and important for clinical trial development. We have been able to describe a pattern that can be considered as characteristic of dysferlinopathy. We have defined the natural history of the disease from a radiological point of view. These results enabled the identification of the most relevant regions of interest for quantitative MRI in longitudinal studies, such as clinical trials.Clinical trial registration: NCT01676077.

Objective. To evaluate the contribution of continuous mode contrast‐enhanced harmonic ultrasonography (CE‐HUS) with a second‐generation contrast agent to the characterization of superficial lymphadenopathies with respect to conventional ultrasonographic techniques (B‐mode and power Doppler). Methods. Fifty‐six lymph nodes from 45 patients were studied both by conventional techniques and by CE‐HUS. The dimensions, intranodal architecture, margins, and location of vessels were evaluated. Subsequently, all the lymph nodes were examined by CE‐HUS, and enhancement of echogenicity was evaluated. The diagnoses obtained by means of fine‐needle aspiration cytologic examination, surgical biopsy, or both were compared with those obtained by ultrasonography. Results. Of the lymph nodes examined, 30 were benign and 26 were malignant (18 metastases and 8 non‐Hodgkin lymphomas). The study using CE‐HUS showed intense homogeneous enhancement in 28 of 30 reactive lymph nodes; perfusion defects in 17, of which 15 were neoplastic and 2 were inflammatory; intense but inhomogeneous speckled enhancement in the early arterial phase in 5 cases of lymphoma; and, last, scarce or absent intranodal enhancement in 4 metastases. The specificity, sensitivity, and accuracy of conventional techniques in differentiation between benign and malignant lymph nodes were 76%, 80%, and 78% versus 93%, 92%, and 92.8% for CE‐HUS. The increase in correct diagnoses was significant (P = .05) when conventional ultrasonography was tested against CE‐HUS. Conclusions. Superficial lymph nodes can be characterized as being neoplastic or benign with a high degree of diagnostic accuracy on the basis of the perfusion characteristics evaluated by CE‐HUS. This technique has been shown to afford a higher degree of accuracy than currently obtainable by any other ultrasonographic technique.