Serum thyroid hormone antibodies are frequent in patients with polyglandular autoimmune syndrome type 3, particularly in those who require thyroxine treatment

Polyglandular autoimmune syndrome (PAS) type 3 consists of autoimmune thyroid disease (AITD) coexisting with ≥1 non-thyroidal autoimmune disease (NTAID) other than Addison’s disease and hypoparathyroidism. We evaluated the prevalence and repertoire of thyroid hormones antibodies (THAb) in PAS-3 patients. Using a radioimmunoprecipation technique, we measured THAb (T3IgM, T3IgG, T4IgM, and T4IgG) in 107 PAS-3 patients and 88 controls (patients with AITD without any NTAID). Based on the selective coexistence of AITD with one NTAID (chronic autoimmune gastritis, non-segmental vitiligo or celiac disease), patients were divided into group 1 (chronic autoimmune gastritis positive, n = 64), group 2 (non-segmental vitiligo positive, n = 24), and group 3 (celiac disease positive, n = 15). At least one of the four THAb was detected in 45 PAS-3 patients (42.1%) and 28 controls (31.8%, P = 0.14), with similar rates in the three PAS-3 groups. The rates of T3Ab, T4Ab, and T3 + T4Ab were similar in groups 1 and 2, while in group 3, T3Ab was undetected (P = 0.02). In PAS-3 patients, the rate of levothyroxine treatment was greater in THAb-positive patients compared to THAb-negative patients (76.7 vs. 56.1%, P = 0.03, RR = 1.4, 95% CI 1.03–1.81). Not unexpectedly, levothyroxine daily dose was significantly higher in group 1 and group 3, namely in patients with gastrointestinal disorders, compared to group 2 (1.9 ± 0.4 and 1.8 ± 0.3 vs. 1.5 ± 0.2 μg/kg body weight, P = 0.0005 and P = 0.004). Almost half of PAS-3 patients have THAb, whose repertoire is similar if chronic autoimmune gastritis or celiac disease is present. A prospective study would confirm whether THAb positivity predicts greater likelihood of requiring levothyroxine treatment

Automated classification of focal breast lesions according to S-detect: validation and role as a clinical and teaching tool

Abstract PURPOSE: To assess the diagnostic performance and the potential as a teaching tool of S-detect in the assessment of focal breast lesions. METHODS: 61 patients (age 21-84 years) with benign breast lesions in follow-up or candidate to pathological sampling or with suspicious lesions candidate to biopsy were enrolled. The study was based on a prospective and on a retrospective phase. In the prospective phase, after completion of baseline US by an experienced breast radiologist and S-detect assessment, 5 operators with different experience and dedication to breast radiology performed elastographic exams. In the retrospective phase, the 5 operators performed a retrospective assessment and categorized lesions with BI-RADS 2013 lexicon. Integration of S-detect to in-training operators evaluations was performed by giving priority to S-detect analysis in case of disagreement. 2\u2009 7\u20092 contingency tables and ROC analysis were used to assess the diagnostic performances; inter-rater agreement was measured with Cohen's k; Bonferroni's test was used to compare performances. A significance threshold of p\u2009=\u20090.05 was adopted. RESULTS: All operators showed sensitivity >\u200990% and varying specificity (50-75%); S-detect showed sensitivity >\u200990 and 70.8% specificity, with inter-rater agreement ranging from moderate to good. Lower specificities were improved by the addition of S-detect. The addition of elastography did not lead to any improvement of the diagnostic performance. CONCLUSIONS: S-detect is a feasible tool for the characterization of breast lesions; it has a potential as a teaching tool for the less experienced operators

Elevated Native T1 Values in the Remote Myocardium Supplied by Obstructive Non-infarct Related Coronary Arteries in Post-STEMI CMR

Abstract Background: We hypothesized that native T1 values, in the non-infarct myocardial territories,may differ if supplied by obstructive or non- obstructive coronary arteries.Methods:Consecutive patients (N = 60, mean age 59 years) with first STEMI following primary percutaneous coronary intervention (PCI), underwent 3 Tesla Cardiac MRI (CMR) within 5±2 days. A retrospective review of coronary angiography reports classified coronary arteries as infarct related coronary artery (IRA) and non-IRA. Obstructive coronary artery disease (CAD) was defined as stenosis ≥ 50%.Native T1 values were presented using a 16-segment AHA modelaccording to the three main coronary territories, left anterior descending (LAD), left circumflex (CX) right coronary artery (RCA).Results: The mean native T1 values in the non-IRA were: 1321 ± 40 msec and 1283 ± 32 msec in the LAD ≥ 50% vs. LAD &lt; 50% stenosis, respectively (P=0.016), 1345 ± 61 msec and 1295 ± 36 msec in the RCA ≥ 50% vs. RCA &lt; 50% stenosis,respectively (P=0.007). Cutoff native T1 values for predicting obstructive non-IRA LAD was 1308 msecwith a sensitivity and specificity of 82% and 67%,respectively(AUC 0.76 ,95% CI 0.57 - 0.95, p = 0.04). Cutoff native T1 values for predicting obstructive non-IRA RCA was 1302 msecwith a sensitivity and specificity of 55% and 83%, respectively(AUC 0.7 95% CI 0.52-0.87, p = 0.05).Logistic regression to predict obstructive non-IRAafteradjustment for age showed T1 was an independent predictor of obstructive non-IRA LAD OR=4.5 (1.33-24.06), p=0.04 and obstructive RCA OR=2.23 (1.12-5.65), p=0.05. Conclusion: Non-IRA obstructive native T1 values are significantly higher as compared with non-obstructive native T1 values. These results suggest the presence of concomitant remote myocardial impairment in the non-IRA territories with obstructive CAD. Trial registration: 5897-19-SMC.</jats:p

Prospective comparative evaluation of quantitative-elastosonography (Q-elastography) and contrast-enhanced ultrasound for the evaluation of thyroid nodules: Preliminary experience

Purpose: To assess the effectiveness of semiquantitative elastosonography (Q-elastography) compared with contrast-enhanced ultrasound (CEUS) in differentiating the nature of thyroid nodules. Methods and materials: Forty-eight consecutive patients (35 males, 13 females, range: 34-69 years, mean: 49.4 years), candidate to surgery, previously detected at color-Doppler ultrasound (CDUS), were prospectively examined with elastosonography with dedicated semiquantitative software (Q-Elastography, Toshiba XG) and CEUS (Technos Mylab 70 Gold X, and Toshiba XG) before surgery. CEUS and elastosonography were evaluated by two investigators in consensus. Comparison between the CEUS pattern and elastonographic strain ratio observed and expected frequencies for the diagnoses was evaluated with chi(2) test or with Fisher exact test. Results: Fifty-three nodules (19 papillary carcinoma, 32 hyperplasia, and 2 follicular adenoma) in 48 patients were available for analysis. Regarding echogenicity score, sensitivity, specificity, PPV and NPV of conventional US were 81%, 50%, 56%, 77%; according to Q-elastography, sensitivity, specificity, PPV and NPV were 95%, 88%, 97% and 91% respectively; whereas concerning CEUS, sensitivity specificity PPV and NPV were 79%, 91%, 83% and 89% respectively. Both CEUS and Q-elastography were more specific than US (p < 0.01), with not statistical significant difference with regard to sensitivity. Conclusions: The results of the present study suggest that Q-elastography is a valuable tool in the characterization of thyroid nodules and it seems to be more sensitive than CEUS. (C) 2013 Elsevier Ireland Ltd. All rights reserved

Metastatic signet ring cell carcinoma presenting as a thyroid diffuse involvement: report of a case studied with Q-elastographic and acoustic radiation force impulse imaging features

Metastatic carcinomas to the thyroid are rare in daily clinical practice. However, when encountered they represent a diagnostic challenge, since it is difficult to distinguish them from primary thyroid lesions, especially when occurring in patients with occult malignant history. Nevertheless, it is critical to differentiate a metastatic tumor from primary thyroid lesions, as the clinical management and the prognosis are different for the two entities. More recently, elastosonography opened new possibilities to ultrasound in different fields, such as thyroid nodule differentiation. Herein, we report a case of metastatic signet ring cell carcinoma to the thyroid studied with quantitative elastography and acoustic radiation force impulse imaging