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Objectives: To explore the role of conventional X-ray imaging in detecting vertebral fractures (VFs) in patients with acromegaly, both at diagnosis of disease and at the last clinical visit. The risk factors for VFs were also evaluated. Design and methods: A retrospective cohort study was conducted on 60 consecutive patients with acromegaly, in a tertiary referral centre. Thoracolumbar spine radiography (X-spine) was performed at the last clinical visit during the follow-up in order to detect VFs. Routine chest radiograph, performed as a part of the general evaluation at diagnosis of acromegaly, were retrospectively analysed to screen for baseline VFs. Results: At diagnosis of acromegaly, chest X-ray revealed that 10 (17%) patients had VFs. Of the 50 patients without VFs at diagnosis of acromegaly, 33 (66%) remained unfractured at the last clinical visit (median [IQR] time, 144 [96–192] months after the diagnosis of acromegaly), whereas 17 (34%) had VFs. Overall, 22 patients (37%) had novel VFs detected on X-spine including five patients with previous VFs. Risk factor for incident VFs was the presence of hypogonadism at diagnosis of acromegaly (p= 0.016). Conclusions: In acromegaly patients, conventional X-rays can detect vertebral fractures early at diagnosis of acromegaly. They can also reveal incident VFs, which may occur several years later even in patients without VFs at diagnosis, above all in relation to hypogonadism.

Abstract: Background: The demand for adequate tissue sampling to determine individual tumor behavior is increasing the number of lung nodule resections, even when the diagnosis is already recognized. Video-assisted thoracic surgery (VATS) is the procedure of choice for diagnosis and treatment of small pulmonary nodules. Difficulties in localizing smaller and deeper nodules have been approached with different techniques. Herein we report our 13-years’ experience with radio-guided thoracoscopic resection. Methods: Patients with pulmonary nodules smaller than 1 cm and/or deeper than 1 cm, below the visceral pleura, underwent computed tomography (CT)-guided injection of a solution, composed of 0.2 ml 99Tc-labeled human serum albumin microspheres and 0.1 ml nonionic contrast, into the nodule. During the VATS procedure, an 11-mm-diameter collimated probe connected to a gamma ray detector was introduced to scan the lung surface. The area of major radioactivity, which matched with the area of the nodule, was resected. Results: From 1997 to 2009, 573 patients underwent thoracoscopic resection of small pulmonary nodules, 211 with the radio-guided technique. There were 159 men and 52 women, with an average age of 60.6 years (range = 12–83). The mean duration of the surgical procedure was 41 min (range = 20–100). The procedure was successful in 208/211 cases. Three patients (0.5%) required conversion to a minithoracotomy. The mean length of pleural drainage and hospital stay was 2.3 and 3.7 days, respectively. Histological examination showed 98 benign lesions and 113 malignant lesions (61 metastases and 52 primary lung cancers). Conclusion: This study confirms that radio-guided localization of small pulmonary nodules is a feasible, safe, and quick procedure, with a high rate of success. The spread of the sentinel lymph node technique has increased the availability of technology required for RGTS.

The aim of the present study was to establish the usefulness of conventional thyroid ultrasonography (US) and color flow-doppler (CFD) sonography in the assessment of 'cold' thyroid nodules. One hundred and four consecutive patients with thyroid nodules who were to undergo surgery were examined by US and CFD before thyroidectomy. Conventional US evaluated the presence of a halo sign, hypoechogenicity and microcalcifications. The vascular pattern on CFD was classified as follows: Type I, absence of blood flow; Type II, perinodular blood flow; Type III, marked intranodular blood flow. On histology, 30 nodules were diagnosed as malignant (carcinoma, CA) and 74 as benign nodules (BN). On US, the echographic pattern most predictive for malignancy was absent halo sign, which was found in 20/30 CA and in 17/72 BN (P = 0.0001; specificity 77.0%; sensitivity 66.6%). The most specific combination on US, absent halo sign/microcalcifications, was found in 8/30 CA and in 5/74 BN (P < 0.005; specificity 93.2%, sensitivity 26.6%). The Type III pattern on CFD was found in 20/30 CA and 38/74 BN (not statistically significant). The combination of absent halo sign on US with Type III pattern on CFD was found in 15/30 CA and in 8/74 BN (P < 0.0001; specificity 89.0%, sensitivity 50.0%). The combination of absent halo sign/microcalcifications on US with Type III pattern on CFD was the most specific combination of the two techniques, being found in 5/30 CA and in only 2/74 BN (P < 0.01; specificity 97.2%, sensitivity 16.6%). In conclusion, findings on US and CFD become highly predictive for malignancy only when multiple signs are simultaneously present in a thyroid nodule. Thus the predictive value of these techniques increases at the expense of their sensitivity. Only in a small proportion of patients with thyroid carcinoma is US and CFD information highly predictive of malignancy.