Radiology最新文献

Screening with low-dose CT (LDCT) in a high-risk population, as defined by age and smoking behavior, reduces lung cancer-related mortality. However, LDCT screening presents a major challenge. Numerous, mostly benign, nodules are seen in the lungs during screening. The question is how to distinguish the malignant from the benign nodules. Various studies use different protocols for nodule management. The Dutch-Belgian NELSON (Nederlands-Leuvens Longkanker Screenings Onderzoek) trial, the largest European lung cancer screening trial, used distinctions based on nodule volumetric assessment and growth rate. This review discusses key findings from the NELSON study regarding the characteristics of screening-detected nodules, including nodule size and its volumetric assessment, growth rate, subtype, and their associated malignancy risk. These results are compared with findings from other screening studies and current recommendations for lung nodule management. By examining differences in nodule management strategies and providing a comprehensive overview of outcomes specific to lung cancer screening, this review aims to contribute to the broader discussion on optimizing lung nodule management in screening programs.

Background Current guidelines recommend radiofrequency ablation (RFA) as the first-line treatment for benign thyroid nodules. Purpose To compare the efficacy and safety of microwave ablation (MWA) and RFA for the treatment of predominantly solid benign thyroid nodules. Materials and Methods This prospective, randomized, open-label, multicenter study was conducted from August 2019 to February 2023. Participants with nonfunctioning, predominantly solid benign thyroid nodules from five institutions were randomly assigned with a 1:1 ratio to receive MWA or RFA treatment. Participants were followed up for at least 2 years. Primary outcomes were 6-month and 2-year volume reduction rate (VRR) of nodules after ablation. Secondary outcomes included VRR change over time, complications, and technique efficacy (defined as volumetric reduction ≥ 50% of the initial nodule volume). Continuous variables and categorical variables were compared using the t test and the χ² test or Fisher exact test, respectively. Results This study included 76 participants in the MWA group (mean age, 46 years ± 12 [SD]; 58 female participants) and 76 in the RFA group (mean age, 50 years ± 13; 56 female participants). MWA was noninferior to RFA in terms of 6-month (mean difference, -5.6%; P = .01) and 2-year (-2.4%; P < .001) VRR after ablation. Comparing MWA and RFA, no evidence of a difference was observed for VRR change over time (mean difference from mixed-effects analysis, 6.9% [95% CI: -0.5, 13.9]; P = .73) or technique efficacy (91% vs 86%; P = .40). The most common major complication was voice change, which occurred in 6.6% of participants in the MWA group and 1.3% of participants in the RFA group (P = .21). Conclusion MWA and RFA showed comparable efficacy for treating participants with predominantly solid benign thyroid nodules. However, a larger sample size is needed to demonstrate that safety is comparable between the procedures. ClinicalTrials.gov Identifier: NCT04046354 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by McGahan in this issue.

History: A 30-year-old female patient who was 25 weeks pregnant presented to the emergency department with a 1-month history of mild headache and 2 weeks of progressive somnolence and photophobia accompanied by binocular horizontal diplopia and right gaze deviation. The patient also described new neck pain with passive head movements, without neck stiffness. Overall, the pregnancy was uncomplicated, with no high-risk features. Fever, chills, cough, shortness of breath, and abdominal or chest pain were denied. The patient had no history of rash, intravenous drug use, immunosuppressive medication use, or documented congenital abnormalities. She had not traveled recently, although she lived in Vancouver, British Columbia, Canada, 2 years prior to presentation. There was no recent or recurrent bacterial or viral illness. At clinical examination, the patient exhibited a decreased level of alertness and appeared tired. Vital signs were unremarkable, with a normal temperature (37.1 °C). Cranial nerve assessment revealed mild right abducens nerve palsy; neurologic examination was otherwise normal. Fundoscopic examination showed moderate grade 3 papilledema, left greater than right, with obscuration of some of the vessels leaving the disk. A CT scan of the head at admission was interpreted as normal (Fig 1). MRI of the brain performed 5 days later, due to persistent symptoms, revealed infratentorial and supratentorial imaging abnormalities (Figs 2-5). Lumbar puncture revealed high cerebral spinal fluid (CSF) opening pressure (32 cm H₂O; upper limit of normal, 25 cm H₂O). The CSF was clear, and analysis revealed an elevated total nucleated cell count (136 ×10⁶/L; reference range, 0-5 ×10⁶/L), with predominant lymphocytic moderate pleocytosis (100 ×10⁶/L; reference range, 0-5 ×10⁶/L) (59% lymphocytes) and normal glucose (3.3 mmol/L; reference range, 2.2-3.9 mmol/L) and normal total protein (0.27 g/L; reference range, 0.16-0.49 g/L) levels. Blood culture results for mycobacteria and anaerobic and aerobic microorganisms showed no growth. Findings from extensive additional diagnostic workup, including serologic testing for herpes simplex virus, varicella-zoster virus, enterovirus, Brucella, Coccidioides, Histoplasma, and mycobacteria, were negative. The HIV test result was negative, and the CD4 lymphocyte count and complement and immunoglobulin levels were within normal range. Autoimmune screening results were also negative.