Elizabeth R. Stamm

BACKGROUND AND PURPOSE: Ultrasound is a standard technique to detect lymph node metastasis in papillary thyroid cancer. Cystic changes and microcalcifications are the most specific features of metastasis, but with low sensitivity. This prospective study compared the diagnostic accuracy of a predictive model for sonographic evaluation of lymph nodes relative to the radiologist9s standard assessment in detecting papillary thyroid cancer metastasis in patients after thyroidectomy. MATERIALS AND METHODS: Cervical lymph node sonographic images were reported by a radiologist (R method) per standard practice. The same images were independently evaluated by another radiologist using a sonographic predictive model (M method). A test was considered positive for metastasis if the R or M method suggested lymph node biopsy. The result of lymph node biopsy or surgical pathology was used as the reference standard. We estimated relative true-positive fraction and relative false-positive fraction using log-linear models for correlated binary data for the M method compared with the R method. RESULTS: A total of 237 lymph nodes in 103 patients were evaluated. Our analysis of relative true-positive fraction and relative false-positive fraction included 54 nodes with pathologic results in which at least 1 method (R or M) was positive. The M method had a higher relative true-positive fraction of 1.46 (95% CI, 1.12–1.91; P = .006) and a lower relative false-positive fraction of 0.58 (95% CI, 0.36–0.92; P = .02) compared with the R method. CONCLUSIONS: The sonographic predictive model outperformed the standard assessment to detect lymph node metastasis in patients with papillary thyroid cancer and may reduce unnecessary biopsies.

Objective We determined mean main portal vein diameter in healthy patients evaluated with CT, compared this value to the “upper limit of normal” reported previously, and evaluated effects of age, sex, height, and BMI on portal vein diameter. Materials and methods Our cohort of healthy patients underwent abdominal CT as potential renal donors. We excluded patients with evidence of liver or severe cardiac disease. We recorded patients’ age, sex, height, weight, and BMI. Patients’ main portal vein diameters were measured by fellowship-trained abdominal imagers on non-contrast and post-contrast images in axial and coronal projections at a defined location. A general linear mixed model was used for analysis. Results 191 patients with 679 main portal vein measurements were included in the analysis. Mean main portal vein diameter was 15.5 ± 1.9 mm; this value was significantly different from the upper limit of normal of 13 mm commonly referenced in the literature (95% CI: 2.22–2.69 mm higher, p < 0.0001). Portal vein diameter does not vary significantly when measured on axial vs. coronal images. On average, post-contrast main portal veins were 0.56 mm larger compared to non-contrast, (95% CI: 0.40–0.71 mm, p < 0.0071). Patient height and BMI are positively correlated with MPV diameter. Conclusions Normal mean portal vein diameter measured on CT was significantly larger (mean 15.5 mm) than the accepted upper limit of 13 mm. Contrast-enhanced main portal veins are significantly larger (0.56 mm) than unenhanced. Sex, height, and BMI significantly affect main portal vein diameter.

ObjectiveTo determine whether the effect of breastfeeding on childhood measures of adiposity differs across percentiles of childhood body mass index (BMI), subcutaneous (SAT) and visceral (VAT) adipose tissue deposition, ratio of subcutaneous to triceps skinfold (STR), and intramyocellular lipid accumulation (IMCL).DesignRetrospective cohort.SettingDenver, Colorado.ParticipantsFour hundred forty-two children and adolescents aged 6 to 13 years participating in the Exploring Perinatal Outcomes Among Children study (EPOCH) with material recall of infant diet.Main ExposureAdequate (≥6 breast milk–months) vs low (60th percentile for VAT, 85th and 95th percentiles for BMI, and 95th percentiles for SAT and STR) and a null effect for those at the 50th percentile or lower. These effects were independent of sociodemographic, perinatal, and current lifestyle factors. We found no relationship between breastfeeding and IMCL at any percentile of the distribution.ConclusionsRather than shifting the entire distribution of adiposity-related measures in childhood, breastfeeding selectively protects against extremes in body size and fat deposition, reinforcing the American Academy of Pediatrics recommendation for 6 months of exclusive breastfeeding as the optimal infant diet.