Abstract
BackgroundFine needle aspiration biopsy is usually performed to evaluate thyroid lesions. The purpose of this study was to evaluate the usefulness of diffusion weighted imaging to differentiate malignancy of thyroid lesions.MethodsThe study was approved by ethics committee of Shanghai Changzheng Hospital.Forty-two patients, 10 men and 32 women (range: 20–72 years, mean age 42.4 years) with thyroid lesions were included in the study. Routine neck MR and diffusion-weighted MR imaging was performed using multiple b-values. ADC values were computed for the different b-values. Histological results of the thyroidectomy samples were obtained for all the patients. ADC values of benign and malignant thyroid lesions were compared with the pathology results. Logistic regression analysis was used to detect independent parameters for differentiating benign and malignancy of lesions.ResultBased on the histology results there were 28 benign and 14 malignant cases. The difference of ADC value between benign and malignant thyroid lesions was significant for ADC values obtained using b-values of 0 and 300 s/mm2 (p < 0.001). The ADC values were significantly higher in benign lesions (benign ADC: 2.37 ± 0.47 × 10-3 mm2/s vs. malignant: 1.49 ± 0.60 × 10-3 mm2/s). ADC values obtained with b-values of 0 and 300 mm2/s and max nodular diameter was regarded as the two most discriminative parameters for differentiating malignancy. Using the pathology results as a standard reference, area under ROC curve was found to be 0.876 for an ADC cutoff value of 2.17 × 10-3 mm2/s that corresponded to an acquisition with b-values of 0 and 300 mm2/s.ConclusionDiffusion-weighted MR imaging is a promising non-invasive method to differentiate malignancy in thyroid lesions.
Highlights
Fine needle aspiration biopsy is usually performed to evaluate thyroid lesions
Parameters for differentiating lesion malignancy Using histology results to group the Apparent Diffusion Coefficient (ADC) values we found that the ADC values were significantly different (p < 0.001) between benign and malignant lesions for the ADC values computed for b = 300 s/mm2
No obvious difference using T1 weighted imaging (T1WI) and T2 weighted imaging (T2WI) were detected on those thyroid diseases, ADC values of thyroid lesions of Graves’ disease was found much higher than that of sub-acute thyroiditis or Hashimoto's disease
Summary
Fine needle aspiration biopsy is usually performed to evaluate thyroid lesions. The purpose of this study was to evaluate the usefulness of diffusion weighted imaging to differentiate malignancy of thyroid lesions. An increasing incidence of thyroid cancer has been reported worldwide [1,2,3]. Ultrasound is the most common non-invasive and sensitive diagnostic imaging modality for diagnosing thyroid lesions, but there are still no reliable criteria for distinguishing benign from malignant lesions. Despite tremendous improvement in diagnostic techniques such as ultrasound, radionuclide imaging and CT, there is still a big challenge to have a non-invasive and reliable technique to differentiate benign from malignant lesions. Routine T1- and T2-weighted MR imaging can provide information on the location and size of thyroid lesions. These protocols still don’t have the specificity for distinguishing benign from malignant nodules or assessing the functional status of these thyroid nodules
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