Tomasz Nowicki

Purpose: Ultrasonography is the primary diagnostic tool for evaluating thyroid nodules. The Thyroid Imaging Reporting & Data System (TIRADS) aims to standardise assessment and reduce fine-needle aspiration biopsies through risk stratification. This pilot study examined knowledge and utilisation of TIRADS among Polish physicians, their perception of the usefulness of TIRADS application and the extent of knowledge of individual nodule features included.Material and methods: An internet-based questionnaire about TIRADS use in clinical practice was sent out to Polish Ultrasound Society members. Information on the responder’s experience with thyroid ultrasound and knowledge and use of TIRADS was assessed and analysed.Results: Out of 159 physicians, 66.6% did not use TIRADS despite 43.4% being aware of its existence. EU-TIRADS was the most commonly adopted classification (50.9%). Participants who adopted TIRADS were younger (p = 0.047) and more likely to be radiologists (p < 0.01). TIRADS use was more prevalent in university clinical hospitals (p = 0.02), among physicians doing thyroid ultrasound as their primary professional activity (p < 0.01), those performing > 100 thyroid ultrasound examinations per year (p < 0.01) and those involved with thyroid fine-needle aspiration biopsy (p < 0.01). The purposes of TIRADS adoption (p < 0.01) and included imaging features (p < 0.01) were more accurately recognized by TIRADS users.Conclusions: TIRADS utilization among Polish clinicians is limited, despite awareness of the classification’s existence. Knowledge of TIRADS components and the purpose of its application among users is satisfactory. Further training and TIRADS adoption should be encouraged, especially in the light of the recent EU-TIRADS-PL guidelines recom­mended by the Polish Scientific Societies.

WPŁYW ŚRODKÓW KONTRASTUJĄCYCH NA ŚRODOWISKO NATURALNE 203 ABSTRACT Contrast media are used in imaging modalities such as x-rays, ultrasound, computed tomography and magnetic resonance. Contrast media enhance tissues to help make a diagnosis. This review covers information about types of contrast agents, their chemical compositions, routes of administration, imaging applications and biological effects. Scientific studies indicate the presence of contrast agents in wastewater. They are not fully removed in conventional treatment processes and therefore enter surface waters with treated wastewater. At the University Clinical Center in Gdansk, the most frequently used contrast agents are iodinated contrast media, secondly gadolinium contrast agents. Iodinated contrast media are pharmaceuticals which are metabolically stable during their passage through the body and are excreted into wastewater. All transformation products of the iodinated contrast medium iopromide were found in municipal effluents because of their formation during biological wastewater treatment. Four products formed at the end of the transformation pathway were also found in bank filtrate and in groundwater of a wastewater irrigation area. The contrast agents themselves do not carry a risk of toxicity, but it can be predicted from the chemical structure that the transformation products may be toxic and mutagenic. On the other hand, MRI contrast agents can cause histopathological changes. Gadolinium deposition in tissues has been proven. The toxicity of gadolinium is well known. Further research on the toxicity of gadolinium contrast agents is needed to be able to prevent unwanted consequences and produce safe contrast agents. Conventional methods currently used do not ensure high efficiency of removing pharmaceuticals from wastewater, which makes it necessary to introduce advanced methods of treatment. The article presents strategies for removal of the compounds in wastewater-treatment plants

Objectives: To evaluate carotid body visibility in contrast-enhanced magnetic resonance (MR) studies and to compare the results to contrast-enhanced computed tomography (CT). Methods: Two observers separately evaluated MR and CT examinations of 58 patients. MR scans were acquired with contrast-enhanced isometric T1-weighted water-only Dixon sequence. CT examinations were performed 90 s after contrast agent administration. Carotid bodies’ dimensions were noted and their volumes calculated. To quantify the agreement between both methods, Bland–Altman plots were computed. Receiver operating characteristic (ROC) and its localization-oriented variant (LROC) curves were plotted. Results: Of the 116 expected carotid bodies, 105 were found on CT and 103 on MR at least by a single observer. Significantly more findings were concordant in CT (92.2%) than in MR (83.6%). The mean carotid body volume was smaller in CT (19.4 mm³) than in MR (20.8 mm³). The inter-observer agreement on volumes was moderately good (ICC (2,k) 0.42, p < 0.001), but with significant systematic error. The diagnostic performance of the MR method added up to 88.4% of the ROC’s area under the curve and 78.0% in the LROC algorithm. Conclusions: Carotid bodies can be visualized on contrast-enhanced MR with good accuracy and inter-observer agreement. Carotid bodies assessed on MR had similar morphology as described in anatomical studies.

A variety of non-neoplastic diseases and benign and malignant lesions may involve parotid glands. In clinical practice, effective diagnosis is crucial to ensure proper treatment and achieve a good therapeutic effect. Unclear anamnesis and short medical history are factors that make diagnosis difficult, especially when cancer should be excluded. We present a case series of four patients who reported to the outpatient clinic with a unilateral nodule in the parotid region. The clinical presentation prevented an unequivocal diagnosis. The suspicion of a neoplastic disease resulted in profound diagnostics, including repeated cytology, ultrasound and magnetic resonance examination. Combining all the acquired information and follow-up, or a histopathologic examination, facilitated the final diagnosis. In all cases, thrombosis was diagnosed. We then analysed the diagnostic process and the associated difficulties. When thrombosis in vascular malformation occurs in the parotid region, it may have an unclear clinical and radiological presentation. Such an image can imitate both benign and malignant tumours. Ambiguous imaging in conjunction with blood cells in cytology should result in the inclusion of thrombosis in vascular malformations in the differential diagnosis.

Aim: The aim of this prospective study is to identify quantitative intravoxel incoherent motion and dynamic contrast-enhanced magnetic resonance imaging parameters of the most frequent benign parotid tumors, compare their utility and diagnostic accuracy. Methods: The study group consisted of 52 patients with 64 histopathologically confirmed parotid focal lesions. Parametric maps representing apparent diffusion coefficient (ADC), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (FP) and transfer constant (Ktrans), reflux constant (Kep), extra-vascular extra-cellular volume fraction (Ve), and initial area under curve in 60 s (iAUC) have been obtained from multiparametric MRI. Results: Statistically significant (p < 0.001) inter-group differences were found between pleomorphic adenomas (PA) and Warthin tumors (WT) in all tested parameters but iAUC. Receiver operating characteristic curves were constructed to determine the optimal cut-off levels of the most significant parameters allowing differentiation between WT and PA. The Area Under the Curve (AUC) values and thresholds were for ADC: 0.931 and 1.05, D: 0.896 and 0.9, Kep: 0.964 and 1.1 and Ve: 0.939 and 0.299, respectively. Lesions presenting with a combination of ADC, D, and Ve values superior to the cut-off and Kep values inferior to the cut-off are classified as pleomorphic adenomas. Lesions presenting with combination of ADC, D, and Ve values inferior to the cut-off and Kep values superior to the cut-off are classified as Warthin tumors. Conclusions: DWI, IVIM and quantitative analysis of DCE-MRI derived parameters demonstrated distinctive features of PAs and WT and as such they seem feasible in differentiation of benign parotid gland tumors.

Ectopic thymic carcinomas are rarely diagnosed in the thyroid gland, let alone in extrathyroid tissues. In the currently available literature, only five cases of extrathyroidal malignancies with thymic differentiation have been reported as arising in the major salivary glands. A 69-year-old female presented with a slow-growing palpable mass in the left parotid gland. Fine needle aspiration biopsy suggested metastatic cancer, whereas core needle biopsy revealed high-grade squamous cell carcinoma. The patient underwent left radical parotidectomy with selective ipsilateral lymph node dissection and subsequent radiation therapy. The surgical specimen was taken for histopathological examination. Microscopically, the tumor resembled thymic carcinoma. It was composed of large nests of squamoid cells with smooth contours, focally with a syncytial growth pattern, and accompanied by abundant lymphocytes with reactive lymphoid follicles. This appearance resembled a micronodular thymic carcinoma with lymphoid hyperplasia. Moreover, the tumor displayed expression of squamous markers (p40 and p63) and markers of thymic carcinoma (CD5 and CD117). Therefore, the final diagnosis of intrasalivary thymic carcinoma was rendered. The molecular analysis including next-generation sequencing demonstrated no variants of the strong, potential, or unknown clinical significance. The patient remains disease-free at 1-year follow-up. In the current case, we comprehensively present a clinical, microscopic, molecular, and radiological picture of CD5-positive squamous cell carcinoma of the parotid. We postulate that similar cases should be designated as intrasalivary thymic carcinoma analogically to similar thyroid tumors. Our case and the limited literature data indicate they should be distinguished from conventional squamous cell carcinoma of major salivary glands due to their rather favorable prognosis.

Different clinical behaviour influences the importance of differentiating focal nodular hyperplasia (FNH) from other focal liver lesions (FLLs). The aim of this study was to compare the efficacy of contrast-enhanced CT and MRI in the diagnosis of FNH. 157 patients with equivocal FLLs detected in ultrasonography subsequently underwent multi-phase CT and MRI with the use of hepatotropic contrast agent (Gd-BOPTA) in a 1.5 T scanner. Examinations were evaluated by three independent readers. Diagnostic efficacy of different radiological signs of FNH in both CT and MRI was compared and AFROC analysis was performed. 4 hepatocellular adenomas, 95 hepatocellular carcinomas, 98 hemangiomas, 138 metastases and 45 FNHs were diagnosed. In both CT and MRI the radiological sign of the highest accuracy was the presence of the central scar within FNH (0.93 and 0.96 relatively). The sum of two radiological signs in MRI: homogeneous enhancement in hepatic arterial phase (HAP) and enhancing lesion in hepatobiliary phase (HBP) was characterized with high values of sensitivity (0.89), specificity (0.97), PPV (0.82), NPV (0.98) and accuracy (0.96). After inclusion of clinical data into analysis the best discriminating feature in MRI was the presence of enhancing lesion in HBP in patients without cirrhosis. In this regard, efficacy parameters increased to 1.00, 0.99, 0.94, 1.00 and 0.99 accordingly. The area under the curve in AFROC analysis of MRI performance was significantly larger than of CT (p = 0.0145). Gd-BOPTA-enhanced MRI is a more effective method in the differential diagnosis of FNH than multi-phase CT.