Sonographic patterns of thyroid disease were correlated with pathologic findings. Twenty-eight cadaver thyroid glands were prospectively examined with a high-resolution real-time ultrasound scanner. Ultrasound findings were correlated in detail with gross and microscopic findings. Ultrasound is very accurate in detecting architectural variation, adenomatous goiter, and solitary nodules. Ultrasound cannot distinguish benign from malignant nodules, but it can be used to measure changes in nodule size. Glandular asymmetry and multiple solid nodules must be present for confident diagnosis of adenomatous goiter; hemorrhage, necrosis, and calcific spherules may be present in varying amounts. Fibrous septae, dilated follicles, and vascular calcification are found in normal aging thyroid glands. Using these criteria, ultrasonography is very accurate in the diagnosis of adenomatous goiter.
Nine patients with calcification of the gallbladder wall (porcelain gallbladder) were analyzed by ultrasound and the appearance correlated with the CT, radiographic, clinical, and surgical findings. Three distinct patterns were identified: (a) a hyperechoic semilunar structure with acoustic shadowing posteriorly, simulating a stone-filled gallbladder devoid of bile, which was seen in 5 patients; (b) a biconvex , curvilinear echogenic structure with variable acoustic shadowing, seen in all 3 patients with carcinoma of the gallbladder; and (c) an irregular clump of echoes with posterior acoustic shadowing, seen in 1 patient. Potential pitfalls in the diagnosis of gallbladder calcification are presented, and the association between calcification and cancer is emphasized.
Forty computed tomography (CT)-assisted aspirations performed with only hand guidance were prospectively compared with 40 performed with a CT body-stereotaxic system. Although there was no statistically significant difference in lesion size and path length between the two groups, use of stereotaxis compared with hand guidance decreased by 75% the number of needle manipulations required to place a needle within a lesion. With the stereotaxic method, only 43 needle manipulations were required to confirm a needle placement in 40 lesions, with no lesion requiring more than two attempts. Use of stereotaxis decreased the number of localization scans by 80% and biopsy time by 50%. It is concluded that CT-guided needle placements with hand guidance are often inaccurate and, unless the lesion is large, require multiple needle manipulations to place a needle within the lesion. Stereotaxis-guided biopsies, on the other hand, decrease radiation exposure, biopsy time, and trauma from multiple needle punctures.
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