Abstract
PurposeThe aim of the study was to evaluate the role of high b-value (2000 sec/mm2) diffusion-weighted imaging (DWI) by using Readout Segmentation of Long Variable Echo-trains (RESOLVE) in differentiating papillary thyroid carcinomas (PTCs) and papillary thyroid microcarcinomas (PTMCs) from benign thyroid nodules.Materials and methodsConsecutive patients with thyroid nodules scheduled for surgery underwent high b-value DWI with 3 b-values: 0, 800 and 2000 sec/mm2. Signal intensity ratios (SIRs) of thyroid nodules to adjacent normal thyroid tissue on DWI were measured as: SIRb0, SIRb800 and SIRb2000. Apparent diffusion coefficient (ADC) values based on the 3 different b-values were acquired as: ADCb0-800, ADCb0-2000, and ADCb0-800-2000. The 6 diagnostic indicators were evaluated by receiver operating characteristic (ROC) and diagnostic ability was compared between high b-value DWI and Ultrasound (US).ResultsA total of 52 PTCs including 33 PTMCs (38 patients, 8 men and 30 women, aged 45.68 ± 11.93 years) and 62 benign thyroid nodules (46 patients, 7 men and 39 women, aged 48.73 ± 11.98 years) were enrolled into the final statistical analysis. ADCb0-800-2000 had the highest diagnostic ability in differentiating PTCs from benign thyroid nodules with area under curve (AUC) of 0.944, sensitivity of 96.15% and specificity of 85.48%, and PTMCs from benign thyroid nodules with AUC of 0.940, sensitivity of 93.94% and specificity of 85.48%. On the strength of lower false-positive rates than US (14.52% vs. 32.26% for PTCs and 14.52% vs. 32.26% for PTMCs), ADCb0-800-2000 had significantly better diagnostic ability in PTCs (P = 0.002) and PTMCs (P = 0.005).ConclusionHigh b-value (2000 sec/mm2) DWI can contribute to differentiating PTCs and PTMCs from benign thyroid nodules and can be potentially used as an active surveillance imaging method for PTMCs.
Highlights
Papillary thyroid carcinoma (PTC) is the most common malignant lesion of the thyroid gland, accounting for 90% of all thyroid malignant diseases [1]
High b-value (2000 sec/mm2) diffusionweighted imaging (DWI) can contribute to differentiating PTCs and papillary thyroid microcarcinomas (PTMCs) from benign thyroid nodules and can be potentially used as an active surveillance imaging method for PTMCs
When PTC is 10 mm in greatest diameter it is defined as papillary thyroid microcarcinoma (PTMC) according to World Health Organization (WHO) [2]
Summary
Papillary thyroid carcinoma (PTC) is the most common malignant lesion of the thyroid gland, accounting for 90% of all thyroid malignant diseases [1]. High b-value DWI faces technical challenge due to decreased signal-to-noise ratio (SNR) and increased anatomic distortion and artifacts, especially when used in superficial organs, such as the thyroid gland Perhaps because of these problems the utility of high b-value DWI in differentiation between benign and malignant thyroid nodules have not been reported. DWI with sequence of multi-shot readout segmentation of long variable echo-trains (RESOLVE) can improve image quality of the neck and thyroid gland with less susceptibility artifacts, blurring from T2Ã signal decay and distortion [1, 12, 13] This raises the possibility of diagnosing and differentiating thyroid nodules with high b-value (> 1000 sec/mm2) DWI to improve the diagnostic accuracy
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