Role of quantitative diffusion-weighted MRI and 1H MR spectroscopy in distinguishing between benign and malignant thyroid nodules

Elshafey, Rasha; Elattar, Ashraf; Mlees, Mohamed A.; Esheba, Noha E.

doi:10.1016/j.ejrnm.2013.10.001

Cited by 5 publications

(8 citation statements)

References 21 publications

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“…This finding is consistent with the pathological characteristics of thyroid nodules in which major modifications can be observed in follicular-derived neoplasms (33). The specificity was slightly lower than that reported in previous studies (26,27,34), which may be related to the 3D whole-lesion measurement method that includes all heterogeneous components, especially the cystic component, in the malignant nodules, which could increase the D values and improve the false-positive rate. The multiple regression analysis showed that the AUC of D combined with the f value could reach 0.962 ( P = 0.475).…”

Section: Discussioncontrasting

confidence: 76%

“…Using high b-values is important for obtaining real DW images and minimizing the perfusion effect. Some previous studies used a higher b-value (b ¼ 1000 s/mm 2 ) and achieved higher sensitivity and specificity (nearly 100%) in differentiating malignant from benign thyroid nodules (26,27). However, there is a risk of noise contamination and distorted image quality with subsequent, apparently unreliable dispersion coefficient (ADC) measurements.…”

Section: Discussionmentioning

confidence: 99%

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Application of whole-lesion intravoxel incoherent motion analysis using iZOOM DWI to differentiate malignant from benign thyroid nodules

et al. 2018

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Background Intravoxel incoherent motion (IVIM) parameters derived from iZOOM diffusion-weighted imaging (DWI) can be used to quantitatively identify malignant thyroid nodules. However, the criteria are not standardized. Purpose To determine IVIM parameter values derived from iZOOM DWI that can differentiate malignant from benign thyroid nodules. Material and Methods Forty-two patients with 46 pathologically confirmed thyroid nodules. All patients underwent preoperative examinations with conventional and iZOOM DWI. A three-dimensional region of interest was drawn on multiple slices to cover the entire nodule. IVIM parameters (D, pure diffusion; f, perfusion fraction; and D*, pseudodiffusion) were measured. The IVIM parameters of the malignant and benign thyroid nodules were compared using independent samples t-tests, a multiple logistic regression, and receiver operating characteristic (ROC) curve analysis. Results D, D*, and f exhibited good reproducibility. The D and f values in the malignant nodules (D = [0.72 ± 0.14] × 10−3 mm2/s, [29.94 ± 7.36] %) were significantly lower than those in benign nodules (D = [1.23 ± 0.35] × 10−3 mm2/s, [36.00 ± 8.35] %). The D value achieved the highest area under curve (0.939). The optimal cut-off value for D was 0.87 × 10−3 mm2/s (sensitivity = 95.83%, specificity = 90.91%, positive predictive value [PPV] = 92.00%, negative predictive value [NPV] = 95.24%, and accuracy rate = 93.48%). The area under ROC curve (AUC) of D combined with the f value did not significantly differ from that of D. Conclusion IVIM parameter D derived from iZOOM DWI may be helpful in differentiating malignant from benign thyroid nodules.

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Section: Discussioncontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Application of whole-lesion intravoxel incoherent motion analysis using iZOOM DWI to differentiate malignant from benign thyroid nodules

et al. 2018

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“…Many studies 1 5–18 have shown that DWI has the potential to differentiate benign from malignant thyroid nodules. However, the sample sizes of these studies were relatively small, and the findings have been inconclusive.…”

Section: Introductionmentioning

confidence: 99%

Diffusion-weighted MRI in differentiating malignant from benign thyroid nodules: a meta-analysis

Chen

Bao³

et al. 2016

BMJ Open

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ObjectivesTo perform a meta-analysis to evaluate the diagnostic efficacy of diffusion-weighted imaging (DWI) in differentiating malignant from benign thyroid nodules.DesignA meta-analysis.Data sources and study selectionMedical and scientific literature databases were searched for original articles published up to August 2015. Studies were selected if they (1) included diagnostic DWI for differentiating malignant from benign thyroid lesions, (2) included patients who later underwent biopsy and (3) presented sufficient data to enable the construction of contingency tables.Data synthesisFor each study, the true-positive, false-positive, true-negative and false-negative values were extracted or derived, and 2×2 contingency tables were constructed. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) instrument. The heterogeneity test, threshold effect test, subgroup analyses and publication bias analyses were performed.ResultsFrom the 113 identified search results, 15 studies, representing a total of 765 lesions, were included in the meta-analysis. We detected heterogeneity between studies but found no evidence of publication bias. The methodological quality was moderate. The pooled weighted sensitivity was 0.90 (95% CI 0.85 to 0.93); the specificity was 0.95 (95% CI 0.88 to 0.98); the positive likelihood ratio was 16.49 (95% CI 7.37 to 36.86); the negative likelihood ratio was 0.11 (95% CI 0.08 to 0.16); and the diagnostic OR was 150.73 (95% CI 64.96 to 349.75). The area under the receiver operator characteristic curve was 0.95 (95% CI 0.93 to 0.97).ConclusionsQuantitative DWI may be a non-invasive, non-radiative and accurate method of distinguishing malignant from benign thyroid nodules. Nevertheless, large-scale trials are necessary to assess its clinical value and to establish standards regarding b values and cut-off values for DWI-based diagnosis.

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“…The ADC values of malignant thyroid nodules were significantly lower than the ADC values of benign thyroid nodules (P value < 0.0001). A recent study of Elshafey et al [22] also reported high ADC values (1.78 + 0.21 × 10 -3 mm 2 /s) for benign nodules and lower ADC values (0.59 + 0.24 × 10 -3 mm 2 /s) for malignant nodules, and these were statistically significant (P value < 0.0001).…”

Section: Discussionmentioning

confidence: 81%

Can quantitative diffusion-weighted MR imaging differentiate between different subtypes of benign and malignant solitary thyroid nodules?

Abdelgawad

Abdel-Gawad

AbuElCebaa

et al. 2020

Egypt J Radiol Nucl Med

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Background: Diffusion-weighted MR imaging (DWI) is sensitive to changes in the microstructural organization of tissue that may influence water diffusion. It has been utilized in various forms to evaluate head and neck tumors. The apparent diffusion coefficient (ADC) value is a quantitative parameter for distinguishing malignant from benign thyroid nodule. Determination of different pathologic types of the thyroid nodules is crucial for appropriate therapeutic approach. Our point was to assess the utility of apparent diffusion coefficient values in discriminating different subtypes of benign and malignant solitary thyroid nodules using diffusion MRI with pathological correlation. Results: This prospective study included 73 patients who had thyroid nodules. The size of the investigated lesions ranged from 0.6 to 3 cm. Most nodules were benign (79.45%), and most of these benign nodules were adenomatous nodules. There was a significant difference in ADC values of benign and malignant thyroid nodules (P 0.0001), with the mean ADC value for the benign group (1.7 ± 0.12 × 10-3) higher than that for malignant nodule (0.71 ± 0.15 × 10). The sensitivity, specificity, and accuracy of ADC in differentiating between benign and malignant thyroid nodules were 97.5, 94.4, and 99.2%, respectively. We noticed a significant overlap in the ADC value of pathological subtypes and upon reviewing the pathological results, we found insignificant differences in the ADC values of the various subtypes of malignant and benign nodules, with P value ranging from 0.054 to 0.062 between different pathological subtypes. A significant difference was only noted between non-complicated cysts and solid nodules P 0.0001. In our series, an ADC value of 0.92 × 10-3 mm 2 /s or less could be used as an indicator of malignancy, with a sensitivity of 97.5%, a specificity of 94.4%, and an accuracy of 99.2%. Conclusion: Diffusion MRI including ADC values are helpful in differentiation between benign and malignant thyroid nodules but not helpful in differentiating between different subtypes of benign and malignant nodules.

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Role of quantitative diffusion-weighted MRI and 1H MR spectroscopy in distinguishing between benign and malignant thyroid nodules

Cited by 5 publications

References 21 publications

Application of whole-lesion intravoxel incoherent motion analysis using iZOOM DWI to differentiate malignant from benign thyroid nodules

Application of whole-lesion intravoxel incoherent motion analysis using iZOOM DWI to differentiate malignant from benign thyroid nodules

Diffusion-weighted MRI in differentiating malignant from benign thyroid nodules: a meta-analysis

Can quantitative diffusion-weighted MR imaging differentiate between different subtypes of benign and malignant solitary thyroid nodules?

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