TeleFast Rad, Dubai (2026)

30/04/2026

☢️Role of ultrasound in neonatal septic arthritis☢️

✅Ultrasound plays a key, often first-line role in evaluating neonatal septic arthritis, especially because clinical signs can be subtle and early diagnosis is critical to prevent joint destruction.

🔻1. Early detection of joint effusion

* Ultrasound is very sensitive for detecting even small joint effusions (before X-ray changes appear).
* In neonates, the most commonly affected joint is the hip.
* Findings:
* Anechoic or complex fluid in the joint
* Joint capsule distension
* This is often the earliest imaging sign.

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🔻2. Characterization of the effusion

* Helps differentiate:
* Simple (transudate-like) vs
* Complex fluid (suggestive of infection)
* Suspicious features:
* Internal echoes
* Septations
* Debris or pus
* However, ultrasound cannot definitively distinguish septic from sterile effusion → aspiration is needed.

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🔻3. Guidance for diagnostic aspiration

* One of the most important roles
* Ultrasound-guided aspiration:
* Confirms diagnosis (via culture, Gram stain)
* Relieves pressure (especially in hip joint)
* Improves accuracy and safety compared to blind aspiration

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🔻4. Assessment of adjacent soft tissues

* Detects:
* Synovial thickening
* Capsular hyperemia (with Doppler)
* Surrounding cellulitis or abscess
* Helps identify associated osteomyelitis, which is common in neonates due to transphyseal vessels

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🔻5. Monitoring response to treatment

* Serial ultrasound can:
* Track reduction in effusion
* Detect persistent or re-accumulating fluid
* Useful in guiding need for repeat aspiration or surgery

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🔻6. Screening tool in suspected cases

* Ideal because it is:
* Bedside, portable
* No radiation
* Non-invasive
* Especially valuable in unstable neonates

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‼️ Limitations

* Operator-dependent
* Cannot assess bone marrow → MRI is superior for:
* Early osteomyelitis
* Deep soft tissue extension
* Cannot confirm infection without aspiration

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❇️Bottom line

Ultrasound is essential for early detection, guidance of aspiration, and follow-up in neonatal septic arthritis, but definitive diagnosis relies on joint fluid analysis, and MRI complements ultrasound when complications are suspected.

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12/02/2026

⚠️Pelvic Congestion Syndrome⚠️
It is a cause of chronic pelvic pain due to dilated, incompetent pelvic veins—basically the pelvic version of varicose veins.

🔻☢️ Radiological Diagnosis☢️🔻

🥇 1️⃣ Catheter Venography (Gold Standard)

This is the definitive radiologic test and is usually performed when embolization is planned.

🔻Diagnostic Venographic Criteria:

✔ Ovarian vein diameter > 6 mm
✔ Reflux of contrast in the ovarian vein (especially left)
✔ Filling of dilated, tortuous pelvic venous plexus
✔ Delayed contrast clearance (venous stasis)
✔ Cross-pelvic filling of contralateral veins
✔ Opacification of v***ar, perineal, or thigh varices from pelvic veins

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🥈 2️⃣ Transvaginal Doppler Ultrasound (First-Line Imaging)

Best initial, noninvasive modality.

🧠 Key point: Demonstration of reflux is more important than size alone.

Dynamic exam (upright or semi-erect + Valsalva) improves sensitivity.
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🥉 3️⃣ MRI (Best Cross-Sectional Modality)

Great for confirming venous congestion and excluding other causes of pelvic pain (endometriosis, adenomyosis).

🔻MRI Findings Suggestive of PCS

✔ Multiple serpiginous flow voids around uterus and ovaries
✔ Dilated ovarian vein:
• Commonly > 8 mm
✔ Engorged parauterine and parametrial veins
✔ High-signal intensity slow flow on T2
✔ Enhancement of dilated veins post-contrast
✔ Varices extending to v***a or pelvic sidewall
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4️⃣ CT Scan

Less preferred (radiation, supine position reduces venous distension) but often shows PCS incidentally.

🔻CT Features

✔ Dilated ovarian vein (>8 mm often used)
✔ Multiple tortuous enhancing veins in adnexa
✔ Congested uterine/ovarian plexus
✔ Pelvic varices crossing midline

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⚠️ Important Radiology Pitfalls

🔴 Vein size alone is NOT diagnostic
Many women without symptoms have large ovarian veins.

🔴 Supine imaging underestimates reflux
Ultrasound with Valsalva is more sensitive.

🔴 Must correlate with chronic pelvic pain pattern

⚠️☢️Role of interventional radiology in PCS
Interventional radiology is basically the main character in treating Pelvic Congestion Syndrome now — both diagnosing it definitively and fixing the problem in the same sitting.
⸻
🎯 Main Role of IR in PCS:

🥇 1️⃣ Diagnostic Confirmation

Although US/MRI suggest PCS, IR confirms it with venography:
• Selective catheterization of ovarian veins (usually left first)
• Sometimes internal iliac veins
• Demonstrates:
• Venous reflux
• Dilated tortuous pelvic plexus
• Cross-pelvic collateral flow
• Delayed emptying
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💉 2️⃣ Definitive Treatment — Pelvic Vein Embolization

This is now the treatment of choice for PCS.

🔧 What is embolized?
• Refluxing ovarian vein(s)
• ± Internal iliac vein branches (uterine, obturator, pudendal) if contributing

🔻Goal: eliminate reflux and decompress pelvic venous plexus
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29/01/2026

☢️ Variants holding the name“Horseshoe“ rarher than the famous “ Horseshoe Kidney”..?!🤔🧲

🫁 Thorax / Lungs

🔻Horseshoe lung
• Rare congenital anomaly
• The right and left lungs are connected by a band of lung tissue (isthmus) behind the heart
• Strongly associated with scimitar syndrome

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🧠 Brain

🔻Horseshoe-shaped lateral ventricles
• Seen in agenesis of the corpus callosum
• The lateral ventricles run parallel and curve in a crescent/horseshoe configuration

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🧬 Adrenal glands

🔻Horseshoe adrenal gland
• Extremely rare fusion anomaly
• Often associated with asplenia/polysplenia syndromes and other heterotaxy abnormalities

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08/01/2026

☢️ What is elastography?

🔻Elastography is an ultrasound-based (or MRI-based) imaging technique that measures tissue stiffness (elasticity).
It works on the principle that pathological tissues often have different stiffness than normal tissue—for example, many malignant tumors are stiffer than benign or normal tissue.

Think of it as a “virtual palpation” performed by imaging rather than by hand.

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🔻Types of elastography (Ultrasound-based)

1. Strain elastography (SE)
• Measures tissue deformation after external compression (manual or physiological).
• Qualitative or semi-quantitative
• Results displayed as a color map (soft → hard).
• Operator dependent.

2. Shear Wave Elastography (SWE)
• Uses acoustic pulses to generate shear waves.
• Measures shear wave velocity, converted to stiffness:
• Expressed in kPa or m/s
• Quantitative, reproducible, less operator dependent.

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☢️Role of elastography in thyroid gland pathologies

🔻1. Thyroid nodules (main clinical use)

Elastography helps differentiate benign from malignant nodules.

General principle:
• Malignant nodules → stiffer
• Benign nodules → softer

Typical findings:
• Benign nodules
• Low stiffness
• Elasticity similar to surrounding thyroid tissue
• Malignant nodules (e.g., papillary carcinoma)
• High stiffness
• Often appear predominantly “hard” on elastography

Diagnostic value:
• Improves specificity of conventional ultrasound
• Helps reduce unnecessary FNAC in low-risk nodules
• Adjunct tool, not a replacement for FNAC

Elastography is most useful in indeterminate nodules (TI-RADS 3–4)

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🔻2. Integration with TI-RADS
• Elastography is not part of formal ACR TI-RADS, but:
• Acts as a supporting risk stratification tool
• High stiffness → increases suspicion
• Low stiffness → supports benign nature

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🔻3. Diffuse thyroid diseases

Hashimoto thyroiditis
• Gland shows increased stiffness due to fibrosis and chronic inflammation
• Stiffness correlates with:
• Disease severity
• Degree of fibrosis

Graves’ disease
• May show moderately increased stiffness
• Usually less stiff than Hashimoto thyroiditis

Elastography can help differentiate diffuse thyroid disorders, but this is a secondary application.

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🔻4. Post-treatment follow-up
• Monitoring stiffness changes after:
• Radiofrequency ablation
• Ethanol ablation
• Surgery or radioiodine therapy
• Decreasing stiffness → treatment response

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⚠️Limitations of thyroid elastography
• Less reliable in:
• Cystic or heavily calcified nodules
• Very small nodules (

01/01/2026

☢️MRI in pregnancy — when is it appropriate?☢️

⚠️Short answer: when it will change management and ultrasound isn’t enough. MRI is considered safe in pregnancy when used thoughtfully.

⚠️Safety basics
• No ionizing radiation → unlike CT or X-ray.
• Extensive data show no proven harm to the fetus at 1.5 T (and 3 T when clinically justified).
• Gadolinium contrast: avoid unless there’s a strong, life-saving indication (it crosses the placenta).

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🔺When MRI is appropriate

Use MRI if ultrasound is inconclusive or limited and the result will affect care.

🧠 Fetal indications
• CNS anomalies: ventriculomegaly, agenesis of corpus callosum, posterior fossa abnormalities
• Spinal defects: myelomeningocele, tethered cord
• Thoracic lesions: congenital diaphragmatic hernia, lung masses (CPAM)
• Abdominal/pelvic anomalies: bowel obstruction, renal anomalies
• Suspected placental invasion (accreta spectrum) when US is equivocal

🤰 Maternal indications
• Acute abdomen:
• Suspected appendicitis
• Ovarian torsion
• Biliary or urinary obstruction when US is nondiagnostic
• Neurologic symptoms:
• Stroke, MS relapse, spinal cord compression
• Pelvic masses:
• Characterization of adnexal masses
• Placental disorders:
• Placenta accreta/increta/percreta

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⚠️Timing considerations
• Any trimester: MRI can be done if clinically indicated
• First trimester: avoid unless essential (precautionary, not proven harm)
• Second & third trimesters: commonly used

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🔺When MRI is not first choice
• Routine screening
• When ultrasound provides a clear answer
• If the result won’t change management

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🔺Key take-home points
• ✔ MRI is safe and valuable in pregnancy
• ✔ Use it problem-solving, not routinely
• ❌ Avoid gadolinium unless absolutely necessary
• ✔ Always balance clinical benefit vs necessity

29/12/2025

☢️Cone-Beam CT (CBCT) in Interventional Radiology — why it matters..?

CBCT gives you CT-like 3D imaging right in the angio suite, using the C-arm. Think of it as seeing the anatomy in depth without leaving the table. Here’s how it earns its place in daily IR work:

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1) Pre-procedural planning (on the fly)
• Precise 3D vascular anatomy and organ relationships
• Identifies tumor feeders, variant arteries, and safe access paths
• Useful when prior CT/MRI is outdated or anatomy has shifted

Typical uses
• Liver tumors (TACE, TARE)
• AVMs/AVFs
• Complex pelvic or bronchial arteries

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2) Guidance during the procedure
• Real-time 3D roadmap for catheter/wire navigation
• Needle guidance for percutaneous interventions
• Overlay of CBCT on live fluoroscopy (image fusion)

Examples
• Super-selective embolization
• Tumor ablation (liver, kidney, lung)
• Biopsies and drainages in difficult locations

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3) Assessment of technical success
• Immediate confirmation of:
• Tumor coverage after embolization
• Ablation zone margins
• Stent position and expansion

This reduces the classic “wait for post-procedure CT” uncertainty.

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4) Detection of complications (early)
• Active extravasation
• Non-target embolization
• Organ injury or malpositioned devices

Early detection = faster correction.

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5) Dose and contrast optimization
• Fewer angiographic runs
• Reduced contrast volume (important in renal impairment)
• Often lower total radiation in complex cases (despite higher single-spin dose)

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High-impact clinical applications
• Oncology IR: TACE, TARE, tumor ablation
• Neuro & peripheral AVMs
• EVAR adjunct imaging
• Spine procedures: vertebroplasty, biopsies
• Interventional oncology response assessment

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Limitations to remember
• Lower soft-tissue contrast vs MDCT
• Motion artifacts (breathing, bowel)
• Limited field of view
• Requires operator experience for optimal use

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🔻Bottom line

CBCT turns the angio suite into a hybrid CT lab, improving precision, safety, and confidence—especially in interventional oncology and complex embolization.

23/12/2025

Placental abruption..! What ultrasound can do ✅

1. Detect placental hematoma (when visible)

You may see:
• Retroplacental hematoma (most classic)
• Subchorionic hematoma
• Preplacental hematoma

Appearance depends on age of bleed:
• Acute: hyperechoic / isoechoic (can blend with placenta → easy to miss)
• Subacute: mixed echogenicity
• Chronic: hypoechoic or anechoic

📌 Key point: Isoechoic acute hematomas are the main reason US misses many cases.

2. Assess placental morphology
• Focal placental thickening
• Placental heterogeneity
• Irregular placental–myometrial interface

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3. Evaluate fetal condition
• Fetal heart rate and viability
• Amniotic fluid volume (often ↓)
• Growth restriction in chronic/recurrent abruption

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4. Doppler contribution
• Umbilical artery Doppler:
• Increased resistance
• Absent or reversed end-diastolic flow in severe cases
• Helps assess fetal compromise, not diagnose abruption itself

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What ultrasound cannot reliably do ❌
• Rule out placental abruption
• Sensitivity ≈ 20–50%
• Detect concealed (occult) abruption
• Determine exact timing of placental separation

👉 A normal ultrasound does NOT exclude abruption.

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Sensitivity & specificity
• Sensitivity: low (many false negatives)
• Specificity: high
→ If you see a retroplacental hematoma, it’s highly suggestive

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Practical radiology take-home 🧠
• Always correlate with clinical picture:
• Painful vaginal bleeding
• Uterine tenderness/rigidity
• Fetal distress
• Use US to:
• Support the diagnosis
• Exclude differentials (placenta previa, vasa previa)
• Monitor fetus and placenta
• Never delay management waiting for “positive” ultrasound

07/11/2025

☢️ Abnormal Shape of the Cardiac Shadow in Chest X-ray and Its Diagnostic Value ☢️

🔊 Generalized Enlargement of the Cardiac Shadow:

When the entire heart appears enlarged, it indicates either a global cardiac enlargement or pericardial effusion.
🟢Pericardial effusion produces a smooth, globular or “water-bottle” shaped cardiac shadow. The borders are regular and the cardiophrenic angles are sharp. The lungs usually appear normal. Echocardiography confirms the diagnosis.
🟢Dilated cardiomyopathy also causes generalized enlargement, but the heart borders are less smooth, and pulmonary venous congestion may be seen.
🟢Chronic myocarditis or end-stage cardiac failure can present similarly.

These findings are significant because they point toward global cardiac or pericardial pathology, prompting further echocardiographic evaluation.

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🔊Segmental or Chamber-Specific Enlargement

Changes in the contour of specific parts of the cardiac silhouette can indicate enlargement of individual chambers.
🟢Left atrial enlargement produces a double right heart border, a bulge along the left upper cardiac margin, and elevation of the left main bronchus. It commonly occurs in mitral stenosis or mitral regurgitation.
🟢Right atrial enlargement makes the right heart border more convex and extends it laterally. It is usually caused by tricuspid valve disease or atrial septal defect.
🟢Left ventricular enlargement shifts the apex downward and laterally, giving an elongated appearance. Hypertension and aortic regurgitation are common causes.
🟢Right ventricular enlargement elevates the apex and fills the retrosternal space on the lateral view. This is often seen in pulmonary hypertension or congenital shunts such as atrial or ventricular septal defect.
🟢Aortic k**b prominence gives a bulge at the upper left border and is due to aortic aneurysm, hypertension, or atherosclerosis.
🟢Pulmonary artery segment prominence causes convexity of the mid-left cardiac border and indicates pulmonary hypertension or left-to-right shunts.

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🔊Characteristic Silhouettes in Congenital Heart Disease

Certain congenital heart conditions produce distinctive cardiac shapes on chest X-ray:
🟢A “water-bottle” or “flask-shaped” heart suggests pericardial effusion.
• A “boot-shaped” (coeur-en-sabot) heart is characteristic of Tetralogy of Fallot, caused by right ventricular hypertrophy and an upturned apex.
🟢An “egg-on-string” or “egg-on-its-side” appearance is typical of transposition of the great arteries, with a narrow mediastinum.
🟢A “snowman” or “figure-of-eight” heart shape suggests total anomalous pulmonary venous return (TAPVR).
🟢A “box-shaped” heart is seen in Ebstein’s anomaly due to gross right atrial enlargement.
🟢A “straight left heart border” is seen in mitral stenosis with left atrial enlargement

30/10/2025

☢️Placenta Previa ..! – Radiological Diagnosis ☢️

❇️ Placenta previa = implantation of the placenta in the lower uterine segment, partially or completely covering the internal cervical os.

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✅1. Imaging Modalities

🔸A. Ultrasound (Modality of choice)
• Transabdominal (TAS):
Initial screening method.
May be limited by bladder filling, fetal head, or maternal habitus.
🔸B. Transvaginal (TVS):
• Gold standard for diagnosis.
• Safe and gives precise localization of the placental edge relative to the internal os.

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👁️‍🗨️ Sonographic Features

🟰 A. Placental location
• Placenta seen in lower uterine segment, extending toward or covering the internal cervical os.

*️⃣ B. Classification (based on relationship to internal os):
1. Low-lying placenta: edge within 2 cm away → normal.

⸻
4. Doppler Findings (if used)
• Normal vascular pattern.
• Used mainly to rule out placenta accreta spectrum if placenta previa is present (look for loss of clear zone, bridging vessels, lacunae, etc.).

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5. Pitfalls & Precautions
• Overdistended bladder may falsely elongate cervix and give false-positive diagnosis.
• Underfilled bladder may obscure the lower segment.
• Placental location should be re-evaluated after 28–32 weeks since it may “migrate” upwards as uterus grows.

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6. MRI Role
• Not routinely needed.
• Used if placenta accreta spectrum is suspected (to assess depth of invasion).

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7. Key Points
• TVS is safe even with bleeding.
• Always report:
• Placental location (anterior/posterior/fundal/low-lying)
• Distance from internal os
• Any evidence of accreta spectrum
• Placental thickness and morphology

09/10/2025

☢️What are diffusion tensor imaging & tractography ?

Diffusion Tensor Imaging (DTI) and Tractography are advanced MRI techniques that visualize and analyze the white matter pathways (nerve fiber tracts) in the brain and spinal cord.
Here’s a clear explanation of each:

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🧠 1. Diffusion Tensor Imaging (DTI)

🔸Definition:
DTI is an MRI technique that measures the diffusion (movement) of water molecules within tissues—especially in white matter of the brain.

🔸Key Concept:
• In the brain’s white matter, water molecules tend to move along the direction of axon fibers (anisotropic diffusion) rather than equally in all directions (isotropic diffusion).
• DTI uses this property to infer the orientation and integrity of white matter tracts.

‼️What DTI measures:
• FA (Fractional Anisotropy): how directional the diffusion is; higher FA = healthier, more organized white matter.
• MD (Mean Diffusivity): how freely water diffuses overall; higher MD = possible damage or loss of tissue density.
• AD (Axial Diffusivity): diffusion along the main fiber axis.
• RD (Radial Diffusivity): diffusion perpendicular to the fibers.

✅Clinical uses:
• Detecting white matter injury (e.g., in trauma, multiple sclerosis, or stroke).
• Assessing brain development or aging.
• Evaluating tumor infiltration.
• Pre-surgical planning to avoid important fiber tracts.

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🧩 2. Tractography

🔸Definition:
Tractography is a 3D reconstruction technique based on DTI data that visually maps out the pathways of white matter tracts in the brain.

🔸How it works:
• The DTI provides the direction of diffusion in each small voxel.
• Tractography algorithms connect voxels that share similar diffusion directions, creating virtual “fiber tracts.”

🔸Output:
A 3D map showing the major neural pathways—like the corticospinal tract, corpus callosum fibers, or arcuate fasciculus.

‼️Applications:
• Neurosurgical planning: identify and preserve vital tracts during brain surgery.
• Neurological research: study connectivity and brain network organization.
• Clinical diagnosis: visualize tract disruption after stroke, tumor, or demyelination.

25/09/2025

☢️ACR TI-RADS Scoring System ☢️

✅Each thyroid nodule is scored based on ultrasound features in 5 categories:
🔸1. Composition
• Cystic or almost completely cystic = 0
• Spongiform = 0
• Mixed cystic and solid = 1
• Solid or almost solid = 2
🔸2. Echogenicity
• Anechoic = 0
• Hyperechoic or isoechoic = 1
• Hypoechoic = 2
• Very hypoechoic = 3
🔸3. Shape
• Wider-than-tall = 0
• Taller-than-wide = 3
🔸4. Margin
• Smooth = 0
• Ill-defined = 0
• Lobulated or irregular = 2
• Extra-thyroidal extension = 3
🔸5. Echogenic foci
• None / large comet-tail = 0
• Macrocalcification = 1
• Peripheral (rim) calcification = 2
• Punctate echogenic foci (microcalcifications) = 3

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✅Risk Categories

After summing the points:
🔸TR1 (0 points): Benign → 0% risk
🔸TR2 (2 points): Not suspicious → ~2% risk
🔸TR3 (3 points): Mildly suspicious → ~5% risk
🔸TR4 (4–6 points): Moderately suspicious → ~10% risk
🔸TR5 (≥7 points): Highly suspicious → ~35% risk

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‼️Biopsy Recommendations (FNA thresholds)
🔸• TR1 & TR2: No FNA
🔸• TR3: FNA if ≥2.5 cm (follow-up if ≥1.5 cm)
🔸• TR4: FNA if ≥1.5 cm (follow-up if ≥1 cm)
🔸• TR5: FNA if ≥1 cm (follow-up if ≥0.5 cm)

TeleFast Rad

30/04/2026

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08/01/2026

01/01/2026

29/12/2025

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