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A comparative prospective study of technetium-99m methoxyisobutylisonitrile (MIBI) and thallium-201 with early (15 min) and delayed (90 min for MIBI, 3 h for 201Tl) imaging in the differentiation of thyroid lesions is presented. Forty patients with cold thyroid nodules visualised on 99mTc-pertechnetate scan and with dyskaryotic or atypical epithelial cells verified by fine needle aspiration biopsy underwent MIBI and 201Tl scintigraphy at 3-day intervals. Subsequent thyroidectomies were carried out in all patients. Semiquantitative analysis was performed using a lesion to non-lesion ratio on early (ER) and delayed images (DR). Additionally, a retention index (RI) was calculated using the formula RI=(DR-ER) x 100/ER. The reproducibility of the method for the early and delayed measurements was tested by analysing intra- and inter-observer variability and repeatability coefficients. Histopathologically, the nodules were found to be well-differentiated thyroid cancer in 21 patients and benign in 19 patients. There was no significant difference in the ER between malignant and benign lesions for either 201Tl or MIBI (P>0.05). However, for both agents significant differences were found between malignant and benign lesions with regard to DR (P<0.01 for 201Tl and P<0.001 for MIBI) and RI (P<0.001 for both agents). Statistical comparison of the two agents showed no significant differences (P>0.05) except with regard to DR and RI in malignant nodules (P<0.05). A receiver operating characteristic analysis was performed to determine threshold levels for the differentiation of malignant from benign nodules. Following this analysis, ER, DR and RI levels of 1.03, 1.54 and 2 for MIBI and < or =1.42, 1.24 and 5 for 201Tl were selected. Using these threshold levels, the sensitivity, specificity and accuracy of the study were 90.5%, 36.8% and 65% for ER MIBI, 61.9%, 94.7% and 77.5% for DR MIBI, 95.2%, 89.4% and 92.5% for RI MIBI, 85.7%, 47.3% and 67.5% for ER 201Tl, 80.9%, 73.6% and 77.5% for DR 201Tl, and 90.5%, 94.7% and 92.5% for RI 201Tl. In conclusion, the DR for MIBI and 201Tl is superior to the ER in detecting malignant nodules, and the RI for both MIBI and 201Tl is more valuable than the DR in differentiating malignant from benign thyroid nodules.

CT-guided percutaneous transthoracic biopsy of the lung is a well-established method for diagnosis of pulmonary lesions yielding a diagnostic accuracy of 71%-95% (1-5), with pneumothorax being the most common complication varying between 17% and 26% (5-7). Currently coaxial technique is more commonly employed than the non-coaxial technique. The risk of pneumothorax may play a decisive role on this preference. Theoretically, fewer pleural passes means less risk of pneumothorax with the coaxial technique. However, introduction of relatively large bore needles are needed in the coaxial technique, which is a known risk factor for the development pneumothorax (8,9). To the best of our knowledge, there are only a few studies on CT-guided transthoracic fine needle aspiration (FNA) biopsies with non-coaxial technique on large patient populations (10, 11).The purpose of this retrospective study was to evaluate the diagnostic accuracy and safety of CT-guided transthoracic biopsy of pulmonary lesions with FNA using the non-coaxial technique. Methods PatientsThe institutional review board approved this retrospective study protocol and waived informed consent.CT images and biopsy records were retrospectively evaluated in 442 patients (346 males [78.3%] and 96 females [21.7%]; mean age, 64±10.8 years; range, 22-89 years) who underwent CT-guided transthoracic FNA of pulmonary lesions between July 2011 and June 2015. Bronchoscopy or transbronchial biopsies were nondiagnostic or not feasible in these patients.Exclusion criteria for the procedure were lesions <5 mm in maximum diameter, lesions suspected to be of vascular origin, uncorrectable coagulopathy (international normalized ratio ≥1.5, platelet count <50,000 K/UL), patients who were unable to maintain the appro- I N T E R V E N T I O N A L R A D I O LO G Y O R I G I N A L A R T I C L E PURPOSEWe aimed to evaluate the diagnostic accuracy and safety of computed tomography (CT)-guided biopsy of pulmonary lesions with fine needle aspiration (FNA) using non-coaxial technique. METHODSWe analyzed 442 patients who underwent CT-guided lung biopsy with FNA and non-coaxial technique to determine the diagnostic outcomes, complication rates, and independent risk factors for diagnostic failure and pneumothorax. RESULTSDiagnostic accuracy, sensitivity, and specificity were 97.6%, 97.3%, and 100%, respectively. Age and >35 mm lesion size were significant risk factors for diagnostic failure. The rates of pneumothorax and chest tube placement were 19% and 2.9%, respectively. Middle and lower lobe location, lesion to pleura distance >7.5 mm, and >45° needle trajectory angle were significant risk factors for pneumothorax. CONCLUSIONCT-guided FNA of pulmonary lesions with non-coaxial technique is a safe and reliable method with a relatively low pneumothorax rate and an acceptably high diagnostic accuracy.

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Purpose The aim of this retrospective study is to evaluate the preoperative screening performance of chest CT (computerized tomography) examination to detect COVID-19 positive individuals. Materials and methods In this retrospective study 218 adult patients who had preoperative chest CT and RT-PCR were enrolled. CT imaging results, which have been reported according to the Radiological Society of North America expert consensus on COVID-19, were collected from the picture archiving and communicating system. Demographic data, planned surgeries, and postoperative outcomes were collected from the electronic patient records. Results One patient (0.5%) showed typical CT features for COVID-19 pneumonia; 12 patients (5.5%) were reported as indeterminate, and eight (3.7%) were reported as atypical for COVID-19 pneumonia. Only one of the three patients with positive RT-PCR had abnormalities on CT. When RT-PCR tests were taken as reference, the sensitivity, specificity, and accuracy of chest CT in showing COVID-19 infection in asymptomatic patients were 33.3%, 90.7%, and 90.0%, respectively. Conclusion Chest CT screening for COVID-19 has a very low yield in asymptomatic preoperative patients and shows false-positive findings in 9.2% of cases, potentially leading to unnecessary postponing of the surgery.