Quantitative Analysis of Thyroid Blood Flow and Static Imaging in the Differential Diagnosis of Thyroid Nodules

Li-Ping Song,Wen-Hong Zhang,Na Zhao,Yang Xiang

doi:10.7314/apjcp.2013.14.11.6331

Li-Ping Song, Wen-Hong Zhang + Show 2 more

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https://doi.org/10.7314/apjcp.2013.14.11.6331

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Abstract

To evaluate the performance of combined quantitative analysis of thyroid blood flow and static imaging data in the differential diagnosis of thyroid nodules. Thyroid blood flow and static imaging were performed in 165 patients with thyroid nodules. Patients were divided into a benign thyroid nodule group (BTN, n=135) and a malignant thyroid nodule group (MTN, n=30) based on the results of post-surgical pathologic examination. Carotid artery thyroid transit times (CTTT), perfusion ratio of thyroid nodule blood/thyroid blood (TNB/TB), and perfusion ratio of thyroid nodule blood/carotid artery blood (TNB/CAB) were measured using thyroid blood flow imaging. The ratios between thyroid nodule and ipsilateral submandibular gland (TN/ SG) and thyroid nodule and normal thyroid tissue (TN/T) were measured from thyroid static imaging. The differences between the BTN and MTN groups were compared. 1) CTTT was markedly lower in the MTN group than the BTN group, the difference being statistically significant. 2) TNB/TB and TNB/CAB were both significantly higher in MTN than BTN groups. 3) TN/T was significantly lower in MTN group than BTN group. 4) TN/SG was lower in MTN group than BTN group, but the difference was not statistically significant. 5) Using the combination of CTTT and TN/T, the sensitivity, specificity and accuracy were 93.1%, 95.3% and 94.9% respectively for the diagnosis of MTN. Using the combination of CTTT, TNB/TB and TN/T, the sensitivity, specificity and accuracy changed to 89.7%, 100%, and 98.1% respectively. 6) Correlation analysis demonstrated a significant correlation between TN/T and TNB/TB (r=-0.384, P=0.036) and TNB/CAB (r=-0.466, P=0.009) in the MTN group. The combination of quantitative markers from thyroid blood flow and thyroid static imaging had high specificity and accuracy in differential diagnosis of benign and malignant thyroid nodules, thus providing an important imaging diagnostic approach.

Highlights

Thyroid nodule (TN) is a common type of thyroid lesion (Mohammadi et al, 2009) that affects all ages
The benign thyroid nodule (BTN) group consisted of 56 cases of nodular goiter (NG), cases of nodular goiter cystic degeneration (NGCC), 8 cases of inflammatory nodules (IN) and cases of thyroid adenoma (TA)
Thyroid nodule is a common type of thyroid lesion, a frequent surgical disease (Erdem et al, 2010; Alper et al, 2012)

Summary

Introduction

Thyroid nodule (TN) is a common type of thyroid lesion (Mohammadi et al, 2009) that affects all ages. It was reported about 5% of women and 1% of men in the general population had palpable thyroid nodules and the malignancy rate of these thyroid nodules could be up to 5% to 15% (Hegedus, 2004; Dean et al, 2008). Differential diagnosis between benign and malignant thyroid nodules plays an important role in guiding the treatment and determining patients’ prognosis. Primary imaging approaches for differential diagnosis of benign and malignant thyroid nodules include ultrasound and radionuclide thyroid imaging (RNTI). Due to the overlapping two-dimensional images and dependence on subjective judgement of the examiner, standard criteria have yet to be developed for the diagnosis of benign and malignant nodules (Rosario et al, 2005; Tae et al, 2007)

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