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8/17/2019 Jurnal Eka Fix

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Clinical applications of high resolution usg.

. !etection of thyroid and other cer"ical #asses$efore

and after thyroidecto#y.

2. !i%erentiation of $enign fro# #alignant

#asses.

.Ultrasound detects the presence& si'e&

site& nu#$er& characteristics of thyroid nodule

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Nor#al ultrasound anato#y of thyroid(t is located anterior

and lateral to trachea$elo) the le"el ofthyroid cartilage anda$o"e the sternalnotch. *infrahyoid

co#part#ent+

!(,(-(N :

R(/0T AN! L12T LB1-&

(-T03U-

P4RA3(!AL LB1 *56758+

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4

Normal thyroidparenchyma has

homogenous medium tohigh level echogenicity &bounded by a thinhyperechoic line(the

thyroid capsule).

Landmarks to beidentiied!

"idline #$rachea andoesophagus.

Laterally# %ommon%arotid artery '*nterolaterally!+trap

muscles o the neck


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NR3AL !(31N-(N- 2 T04R(! LB1-

A-P LENGTH

N1WBRN 96## 96;5##(N2ANT ;6


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Sonogram of the left lobe of the thyroid gland in the transverse plane showing a rounded lobe of a goiter. L=enlarged lobe, I= widened

isthmus,T=trachea,C=carotid artery,J=ugular vein, S=Sternocleidomastoid muscle, m=strap muscles, !=esophagus.


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“Pattern Recognition of Benign Nodules at

Ultrasound of the Thyroid: Which Nodules Can Be

Left Alone?”

ohn A. Bona"ita& ason 3ayo& a#es Ba$$&

/ene"ie"e Bennet& Thaira )eity& 3ichael3acari& oseph 4ee

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B1CT(,1The purpose of this study was to evaluate morphologic

features predictive of benign thyroid nodules.

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MATERIALS AND METHODS. From a registry of

the records of 1!"! fine#needle aspiration biopsies

performed $ointly by the cytology and radiologydepartments at a single institution between !%%& and

!%%' the cases of (&% patients were identified for

whom both a pathology report and ultrasound

images were available. From the alphabeti)ed listgenerated the first &%% nodules were reviewed. *e

analy)ed the accuracy of individual sonographic

features and of 1% discrete recogni)able

morphologic patterns in the prediction of benignhistologic findings.

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Fig. 1A —(ndi"idual ultrasound features of nodules.9


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Fig. 1B —+ndividual ultrasound features of nodules. ,(#year#

old woman with papillary carcinoma. -ltrasound scan shows

nodule with ill#defined borders

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Fi 1C ( di id l lt d f t f d l


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Fig. 1C —(ndi"idual ultrasound features of nodules.=>6year6old #an )ith papillary carcino#a. Ultrasoundscan sho)s #icrocalcications *arrow+& )hich areeasily confused )ith co#et6tail shado)ing. (#portant

nding is hypoechogenicity of nodule

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Fig. 1D —+ndividual ultrasound features of nodules.

"'#year#old woman with medullary carcinoma.

-ltrasound scan shows macrocalcification.

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Fig 1E +ndividual ultrasound features of


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Fig. 1E —+ndividual ultrasound features ofnodules. "'#year#old woman with papillary

carcinoma. olor Doppler ultrasound image

shows hypervascular nodule.

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Fig. 2A —/orphologic patterns. ,1#year#old man

with colloid nodule. -ltrasound scan shows

spongiform nodule. Similarity of nodule to water#

filled sponge is evident

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Fig. 2B —/orphologic patterns. &!#year#old man

with colloid cyst. -ltrasound scan shows cyst with

colloid clot. *hen cystic portion of nodule is

subtracted type 1 or spongiform nodules remain

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Fig. 2C —/orphologic patterns. !1#year#old woman

with 0ashimotos thyroiditis. -ltrasound scan shows

nodule that loo2s li2e giraffe hide having light

bloc2s separated by blac2 bands

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Fig. 2D —/orphologic patterns. ",#year#old woman

with 0ashimotos thyroiditis. -ltrasound scan shows

3white 2night4 or hyperechoic nodule.

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2ig. ;1 3orphologic patterns. >6year6old)o#an )ith follicular adeno#a. Color!oppler ultrasound i#age sho)s red light&D

or hyper"ascular& nodule.

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Fig. 2F —/orphologic patterns. !5#year#old woman

with papillary carcinoma. -ltrasound scan shows

hypoechoic nodule.

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. .)o#an )ith papillary carcino#a. Ultrasoundscan sho)s isoechoic nodule )ithout halo.Coincidental #icrocalcications *arro)s+ are

e"ident

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Fig. 2H —/orphologic patterns. !year#old man

with nodular goiter. -ltrasound scan shows

isoechoic nodule with halo

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Fig. 2I —/orphologic patterns. &year#old woman

with hyperplastic nodule. olor Doppler ultrasound

image shows 3ring of fire4 or peripheral

hypervascularity.

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RESULTS.

We found that grouping of thyroid nodules intoreproduci$le patterns of #orphology& or patternrecognition& rather than analysis of indi"idualsonographic features& )as eFtre#ely accuratein the identication of $enign nodules. 2ourspecic patterns )ere identied: spongifor#conguration& cyst )ith colloid clot& gira%epattern& and di%use hyperechogenicity& )hichhad a 558 specicity for $enignity. (n ourseries& identication of nodules )ith one ofthese four patterns could ha"e o$"iated #orethan >58 of thyroid $iopsies.

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CONCLUSION.

Recognition of specic #orphologicpatterns is an accurate #ethod of

identifying $enign thyroid nodules thatdo not reGuire cytologic e"aluation.Use of this approach #ay su$stantially

decrease the nu#$er of unnecessary$iopsy procedures.

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THANK YOU

3

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