Signo de  rueda de carreta en los nódulos tiroídeos: ¿Sinónimo de benignidad?

Abstract

Thyroid nodular disease is a highly prevalent condition. Most nodules are asymptomatic and only identifiable on images. We have established a relationship between the particular "spoke wheel" pattern of thyroid masses and a benign histology. A review of our institutional database of thyroid punctured under ultrasound guidance, histologically studied between 2003 and 2011, was performed. Node selection criteria included: mixed /solid, round /oval, surrounded by a halo, with radial structures converging toward a central point, with or without calcifications, and with peripheral vessels along with others oriented toward the center of the thyroid masses. Seventy-nine (2.5%) out of 3.204 punctured masses exhibited this sign. Average size: 28.3 mm. Fifty-eight masses were benign colloid nodules as diagnosed on FNA biopsy. Remaining masses corresponded to Lesion Follicular (4 benign, surgically treated; 7 under follow-up, stable; 10 with no information). Despite being a rare radiologic finding, the "spoke wheel" sign may be another element contributing to ultrasonographic discrimination between benignity and malignancy, especially in large thyroid masses.