• Korean Journal of Radiology
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• 제24권9호
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• pp.912-923
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• 2023

Objective: This study aimed to validate the risk stratification system (RSS) and biopsy criteria for cervical lymph nodes (LNs) proposed by the Korean Society of Thyroid Radiology (KSThR). Materials and Methods: This retrospective study included a consecutive series of preoperative patients with thyroid cancer who underwent LN biopsy, ultrasound (US), and computed tomography (CT) between December 2006 and June 2015. LNs were categorized as probably benign, indeterminate, or suspicious according to the current US- and CT-based RSS and the size thresholds for cervical LN biopsy as suggested by the KSThR. The diagnostic performance and unnecessary biopsy rates were calculated. Results: A total of 277 LNs (53.1% metastatic) in 228 patients (mean age ± standard deviation, 47.4 years ± 14) were analyzed. In US, the malignancy risks were significantly different among the three categories (all P < 0.001); however, CT-detected probably benign and indeterminate LNs showed similarly low malignancy risks (P = 0.468). The combined US + CT criteria stratified the malignancy risks among the three categories (all P < 0.001) and reduced the proportion of indeterminate LNs (from 20.6% to 14.4%) and the malignancy risk in the indeterminate LNs (from 31.6% to 12.5%) compared with US alone. In all image-based classifications, nodal size did not affect the malignancy risks (short diameter [SD] ≤ 5 mm LNs vs. SD > 5 mm LNs, P ≥ 0.177). The criteria covering only suspicious LNs showed higher specificity and lower unnecessary biopsy rates than the current criteria, while maintaining sensitivity in all imaging modalities. Conclusion: Integrative evaluation of US and CT helps in reducing the proportion of indeterminate LNs and the malignancy risk among them. Nodal size did not affect the malignancy risk of LNs, and the addition of indeterminate LNs to biopsy candidates did not have an advantage in detecting LN metastases in all imaging modalities.

• Korean Journal of Radiology
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• 제25권9호
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• pp.851-858
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• 2024

Objective: This study investigates the long-term efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) for treating locally recurrent papillary thyroid cancer (PTC). Materials and Methods: We retrospectively analyzed 39 consecutive patients with 61 locally recurrent PTCs (14 males, 25 females; mean ± standard deviation age, 52.8 ± 16.7 years; range 21-92 years) who underwent US-guided RFA with curative intent between September 2008 and April 2012. A subgroup of 24 patients with 37 recurrent PTCs who had a follow-up of at least 10 years were analyzed separately. All patients were followed for changes in lesion size on US and thyroglobulin (Tg) levels at 1, 3, 6, and 12 months after RFA, with follow-up every 6-12 months thereafter. Any complications were documented during the follow-up period. Recurrence-free survival (RFS) rates were assessed using Kaplan-Meier estimates. Long-term outcomes were evaluated in patients with follow-up of at least 10 years. Results: The follow-up period ranged from 7 to 180 months (median 133 months). The RFS rates for the 39 patients at 3, 5, and 10 years were 86.8%, 75.5%, and 60.6%, respectively. Among the 24 patients with 37 recurrent PTCs followed for more than 10 years, the volume reduction rate was 99.9% (range 96%-100%), and the complete tumor disappearance rate was 91.9%. The mean serum Tg level also decreased significantly, from 2.66 ± 86.5 mIU/L before ablation to 0.43 ± 0.73 mIU/L (P < 0.001) at the final follow-up. In 14 (58.3%) of the 24 patients, Tg levels were undetectable (below 0.08 mIU/L) at the last follow-up. No life-threatening or delayed complications were observed during the 10-year follow-up period. Conclusion: The high RFS throughout the follow-up period, with efficacy and safety lasting beyond 10 years, supports US-guided RFA as a valuable option for local control of recurrent PTCs.

• 임상이비인후과
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• 제29권2호
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• pp.316-320
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• 2018

Esophageal diverticulum is very rare disease. Since it usually has no symptoms, it is hard to find and diagnose. Moreover, if the diverticulum is located nearly to thyroid gland, surgeons sometimes misdiagnose as a thyroid nodule. Here, we represent our case which has papillary thyroid cancer and esophageal diverticulum together. In this case, we experienced the surgical procedure and postoperative complications of the esophageal diverticulum. Even though esophageal diverticulum was in preoperative computed tomography and ultrasound, it was neglected before the surgery so that found during the operation. The purpose of this study was to know the preoperative radiological findings of the esophageal diverticulum and to find out what to be aware of during surgery and how to manage the complications after surgery.

• Korean Journal of Radiology
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• 제25권2호
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• pp.199-209
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• 2024

Objective: This study aimed to compare therapeutic efficacy and technical outcomes between adjustable electrode (AE) and conventional fixed electrode (FE) for radiofrequency ablation (RFA) of benign thyroid nodules. Materials and Methods: Between 2013 and 2021, RFA was performed on histologically proven benign thyroid nodules. For the AE method, AE length ≥ 1 cm with higher power and < 1 cm with lower power were utilized for ablating feeding vessels and nodules, especially those near anatomical structures, respectively. The therapeutic efficacy (volume reduction rate [VRR], complication rate, and regrowth rate) and technical outcomes (total energy delivery, ablated volume/energy, RFA time, and ablated volume/time) of FE and AE were compared. Continuous parameters were compared using a two-sample t-test or Mann-Whitney U test, and categorical parameters were compared using a chi-squared test or Fisher's exact test. Results: A total of 182 nodules (FE: 92 vs. AE: 90) in 173 patients (mean age ± standard deviation, 47.0 ± 14.7 years; female, 90.8% [157/173]; median follow-up, 726 days [interquartile range, 441-1075 days]) were analyzed. The therapeutic efficacy was comparable, whereas technical outcomes were more favorable for AE. Both electrodes demonstrated comparable overall median VRR (FE: 92.4% vs. AE: 84.9%, P = 0.240) without immediate major complications. Overall regrowth rates were comparable between the two groups (FE: 2.2% [2/90] vs. AE: 1.1% [1/90], P > 0.99). AE demonstrated a shorter median RFA time (FE: 811 vs. AE: 627 seconds, P = 0.009). Both delivered comparable median energy (FE: 42.8 vs. AE: 29.2 kJ, P = 0.069), but AE demonstrated higher median ablated volume/energy and median ablated volume/time (FE: 0.2 vs. AE: 0.3 cc/kJ, P < 0.001; and FE: 0.7 vs. AE: 1.0 cc/min, P < 0.001, respectively). Conclusion: Therapeutic efficacy between FE and AE was comparable. AE demonstrated better technical outcomes than FE in terms of RFA time, ablated volume/energy, and ablated volume/time.

• 대한방사선기술학회지:방사선기술과학
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• 제35권3호
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• pp.237-248
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• 2012

출산 후 우울감이 있는 여성의 갑상선질환 빈도가 증가하면서 출산 후 우울증과 갑상선질환의 상관성 여부가 논의의 대상이 되고 있다. 본 연구는 출산 후 우울증의 유병률을 예측하고 초음파검사를 통한 갑상선질환과의 상관성에 대해 연구하고자 한다. 2010년 1월부터 2011년 11월까지 M산부인과에 내원한 출산 후 1년 이내의 환자 230명을 대상으로, 우울증 선별검사와 대상자의 일반적 특성을 조사하였고 갑상선검사는 초음파검사와 혈액검사를 하였다. 대상자 230명 중 비우울집단은 122명(53.0%), 우울집단은 108명(47.0%)이었다. 갑상선 초음파검사에서 갑상선의 크기변화가 있었던 27명 중 비우울집단은 4명 (14.8%)이었고, 우울집단은 23명(85.2%)이었다. 또한 갑상선 결절이 발견된 124명 중 비우울집단은 45명(35.8%)이었고, 우울집단은 79명(64.2%)이었다. 초음파유도하 미세침흡인검사 결과, 양성 33명 중 비우울집단은 15명(45.5%)이었고, 우울집단은 18명(54.5%)이었다. 갑상선염 3명 중 비우울집단은 1명(33.3%)이었고, 우울집단은 2명(66.7%)이었다. 악성 5명은 모두 우울집단에서만 나타났다. 초음파검사를 통한 갑상선의 크기변화, 갑상선 결절의 발생빈도 등 갑상선질환은 우울집단이 비우울집단에 비해 높게 나타났으며 유의한 차이가 나타났다. 갑상선 혈액검사 결과, 비정상적인 갑상선자극호르몬의 수치를 보였던 7명 중 비우울집단은 2명(28.6%)이었고, 우울집단은 5명(71.4%)이었다. 비정상적인 유리티록신의 수치를 보였던 9명 중 비우울집단은 4명(44.4%)이었고, 우울집단은 5명(55.6%)이었다. 갑상선 기능이상은 230명 중 5명이었고, 5명 중 비우울집단에서는 잠재적 갑상선항진증이 2명이었다. 우울집단에서는 잠재적 갑상선저하증이 1명, 잠재적 갑상선항진증이 2명이었고 혈액검사를 통한 두 집단의 유의한 차이가 나타나지 않았다. 본 연구는 출산 후 우울증과 초음파검사를 통한 갑상선질환의 상관성이 나타났으며, 본 연구의 객관적 결과들이 출산 후 우울증과 갑상선질환에 대한 폭넓은 인식과 예방 및 치료의 가이드라인을 제시할 수 있을것이라 사료된다.

• 한국방사선학회논문지
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• 제8권5호
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• pp.241-248
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• 2014

본 연구는 미만성 $^{18}F-FDG$ 갑상선 섭취를 보이는 PET/CT 영상에서 최대 표준섭취계수($SUV_{max}$)와 갑상선 자가 항체(anti-TPO Ab, anti-TG Ab, TSH)들 사이의 임상적 상관관계를 하시모토 갑상선염과 그레이브스병 중심으로 분석하였다. 이를 위하여 2010년 5월부터 2013년 4월까지 건강검진에서 PET/CT 검사를 시행한 환자 1,097명을 대상으로 미만성 FDG 갑상선 섭취 여부를 분석하여 갑상선 기능 검사와 초음파 검사를 추가적으로 시행하였다. 결과적으로 미만성 $^{18}F-FDG$ 갑상선 섭취를 보이는 자가 면역 갑상선 질환 환자는 39명(3.6%)이 발견되었으며 하시모토 갑상선염은 43.6%, 그레이브스병은 23.1% 이었다. 하시모토 갑상선염은 anti-TPO Ab와 anti-TG 수준이 높은 역가의 양성 반응을 보였으며 $SUV_{max}$와 anti-TPO Ab간 상관계수가 통계적으로 유의하였다(r>0.4, p<0.05). 또한 그레이브스병은 대부분의 갑상선 자가 항체의 수준이 높은 역가의 양성 반응을 보였으며 $SUV_{max}$와 TSH간 상관계수가 통계적으로 유의하였다(r>0.5, p<0.01). 따라서 미만성 18F-FDG 갑상선 섭취 증가에 따른 $SUV_{max}$ 수준이 높을수록 하시모토 갑상선염은 anti-TPO Ab 수준이, 그레이브스병은 TSH 수준이 비례적으로 증가됨을 알 수 있었고 이러한 상관관계는 자가 면역 갑상선 질환에 대한 부대 징후를 판단할 수 있는 가장 영향력 있는 척도로서 임상적 적용이 가능할 것으로 판단하였다.

• 한국정보처리학회:학술대회논문집
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• 한국정보처리학회 2021년도 추계학술발표대회
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• pp.443-445
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• 2021

갑상선 결절(thyroid nodule)은 검진 인구에서 빈번하게 진단되는 질환이지만 현재까지 진단방법은 경험적이며 정성적 판단에 의존하고 있는 실정이다. 본 연구는 갑상선 결절을 평가하기 위하여 시행한 초음파 의료영상을 이용하여 정량 분석할 수 있는 소프트웨어를 개발하였으며 갑상선 양성 결절환자에서의 임상활용 가능성을 평가하고자 한다. 임상 연구는 총 13명의 갑상선 양성 결절 환자를 대상으로 하였다. 환자별 갑상선 초음파영상을 이용하여 정상부위와 병변부위에서 정량 지표인 변동계수를 각각 측정하였다. 환자별 정상부위와 병변부위의 변동계수 차이는 대응표본 T 검정을 사용하여 비교하였으며 유의한 차이를 확인할 수 있었다. 본 연구를 통하여 개발한 정량분석 소프트웨어를 실제 갑상선 양성 결절 환자에서 갑상선 결절을 분석·평가하는데 활용할 수 있을 것으로 판단된다.

• Korean Journal of Radiology
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• 제23권10호
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• pp.1019-1027
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• 2022

Objective: Thyroidectomy bed lesions frequently show suspicious ultrasound (US) features after thyroid surgery. Fine-needle aspiration (FNA) may not provide definitive pathological information about the lesions. Although core-needle biopsy (CNB) has excellent diagnostic performance in characterizing suspicious thyroid nodules, no published studies have evaluated the performance of CNB specifically for thyroidectomy bed lesions. Therefore, we aimed to evaluate the diagnostic performance and safety of CNB for characterizing thyroidectomy bed lesions. Materials and Methods: A total of 124 thyroidectomy bed lesions in 113 patients (79 female and 34 male; age, 23-85 years) who underwent US-guided CNB between December 2008 and December 2020 were included. We reviewed the US imaging features of the target lesions and the histories of previous biopsies. The pathologic results, diagnostic performance for malignancy, and complications of CNB were analyzed. Results: All samples (100%) obtained by CNB were adequate for pathological analysis. Pathological analysis revealed inconclusive results in two lesions (1.6%). According to the reference standard, 50 lesions were ultimately malignant (40.3%), and 72 were benign (58.1%), excluding the two inconclusive lesions. The performance of CNB for diagnosing malignant thyroidectomy bed lesions in the 122 lesions had a sensitivity of 98.0% (49/50), a specificity of 100% (72/72), positive predictive value of 100% (49/49), and negative predictive value of 98.6% (72/73). Eleven lesions were referred for CNB after prior inconclusive FNA results in thyroidectomy bed lesions, for all of which CNB yielded correct conclusive pathologic diagnoses. According to the pathological analysis of CNB, there were various benign lesions (58.9%, 73/124) besides recurrence, including benign postoperative lesions other than suture granuloma (32.3%, 40/124), suture granuloma (15.3%, 19/124), remnant thyroid tissue (5.6%, 7/124), parathyroid lesions (4%, 5/124), and abscesses (1.6%, 2/124). No major or minor complications were associated with the CNB procedure. Conclusion: US-guided CNB is accurate and safe for characterizing thyroidectomy bed lesions.

• Korean Journal of Radiology
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• 제24권10호
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• pp.1028-1037
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• 2023

Objective: To evaluate the computed tomography (CT) features for diagnosing metastatic cervical lymph nodes (LNs) in patients with differentiated thyroid cancer (DTC) and validate the CT-based risk stratification system suggested by the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) guidelines. Materials and Methods: A total of 463 LNs from 399 patients with DTC who underwent preoperative CT staging and ultrasound-guided fine-needle aspiration were included. The following CT features for each LN were evaluated: absence of hilum, cystic changes, calcification, strong enhancement, and heterogeneous enhancement. Multivariable logistic regression analysis was performed to identify independent CT features associated with metastatic LNs, and their diagnostic performances were evaluated. LNs were classified into probably benign, indeterminate, and suspicious categories according to the K-TIRADS and the modified LN classification proposed in our study. The diagnostic performance of both classification systems was compared using the exact McNemar and Kosinski tests. Results: The absence of hilum (odds ratio [OR], 4.859; 95% confidence interval [CI], 1.593-14.823; P = 0.005), strong enhancement (OR, 28.755; 95% CI, 12.719-65.007; P < 0.001), and cystic changes (OR, 46.157; 95% CI, 5.07-420.234; P = 0.001) were independently associated with metastatic LNs. All LNs showing calcification were diagnosed as metastases. Heterogeneous enhancement did not show a significant independent association with metastatic LNs. Strong enhancement, calcification, and cystic changes showed moderate to high specificity (70.1%-100%) and positive predictive value (PPV) (91.8%-100%). The absence of the hilum showed high sensitivity (97.8%) but low specificity (34.0%). The modified LN classification, which excluded heterogeneous enhancement from the K-TIRADS, demonstrated higher specificity (70.1% vs. 62.9%, P = 0.016) and PPV (92.5% vs. 90.9%, P = 0.011) than the K-TIRADS. Conclusion: Excluding heterogeneous enhancement as a suspicious feature resulted in a higher specificity and PPV for diagnosing metastatic LNs than the K-TIRADS. Our research results may provide a basis for revising the LN classification in future guidelines.

• Korean Journal of Radiology
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• 제24권12호
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• pp.1284-1292
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• 2023

Objective: We investigated the impacts of computed tomography (CT) added to ultrasound (US) for preoperative evaluation of patients with papillary thyroid carcinoma (PTC) on staging, surgical extent, and postsurgical survival. Materials and Methods: Consecutive patients who underwent surgery for PTC between January 2015 and December 2015 were retrospectively identified. Of them, 584 had undergone preoperative additional thyroid CT imaging (CT + US group), and 859 had not (US group). Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were used to adjust for 14 variables and balance the two groups. Changes in nodal staging and surgical extent caused by CT were recorded. The recurrence-free survival and distant metastasis-free survival after surgery were compared between the two groups. Results: In the CT + US group, discordant nodal staging results between CT and US were observed in 94 of 584 patients (16.1%). Of them, CT accurately diagnosed nodal staging in 54 patients (57.4%), while the US provided incorrect nodal staging. Ten patients (1.7%) had a change in the extent of surgery based on CT findings. Postsurgical recurrence developed in 3.6% (31 of 859) of the CT + US group and 2.9% (17 of 584) of the US group during the median follow-up of 59 months. After adjustment using IPTW (580 vs. 861 patients), the CT + US group showed significantly higher recurrence-free survival rates than the US group (hazard ratio [HR], 0.52 [95% confidence interval {CI}, 0.29-0.96]; P = 0.037). PSM analysis (535 patients in each group) showed similar HR without statistical significance (HR, 0.60 [95% CI, 0.31-1.17]; P = 0.134). For distant metastasis-free survival, HRs after IPTW and PSM were 0.75 (95% CI, 0.17-3.36; P = 0.71) and 0.87 (95% CI, 0.20-3.80; P = 0.851), respectively. Conclusion: The addition of CT imaging for preoperative evaluation changed nodal staging and surgical extent and might improve recurrence-free survival in patients with PTC.