Can Quantitative Diffusion-Weighted MR Imaging Differentiate Benign and Malignant Cold Thyroid Nodules? Initial Results in 25 Patients

Schueller-Weidekamm, Claudia; Kaserer, Klaus; Schueller, Gerd; Scheuba, Christian; Ringl, Helmut; Weber, Michael; Czerny, Christian; Herneth, Andreas M.

doi:10.3174/ajnr.a1338

Cited by 65 publications

(52 citation statements)

References 28 publications

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“…All except one (8) found lower ADCs in malignant thyroid nodules compared to benign nodules, supporting the hypothesis that increased cellularity and reduced extracellular extravascular space restrict water diffusion in malignant nodules (24). However, our results indicated poor sensitivity and specificity for using ADC alone to discriminate benign and malignant pathology.…”

Section: Discussionsupporting

confidence: 62%

Multi‐institutional validation of a novel textural analysis tool for preoperative stratification of suspected thyroid tumors on diffusion‐weighted MRI

Brown

Nagala

McLean

et al. 2015

Magnetic Resonance in Med

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Purpose Ultrasound-guided fine-needle-aspirate-cytology (FNAC) fails to diagnose many malignant thyroid nodules; thus, patients may undergo diagnostic lobectomy. This study assessed whether textural analysis (TA) could non-invasively stratify thyroid nodules accurately using diffusion-weighted (DW) MRI. Methods This multi-institutional study examined 3T DW-MRI images obtained with spin-echo echo-planar-imaging (DW-EPI) sequences. The training dataset included 26 patients from Cambridge, UK and test dataset included 18 thyroid cancer patients from Memorial Sloan-Kettering, USA. Apparent diffusion coefficients (ADCs) were compared over regions-of-interest (ROIs) defined on thyroid nodules. TA, linear discriminant analysis (LDA), and feature reduction using the 21 MaZda-generated texture parameters that best distinguished benign and malignant ROIs. Results Training dataset mean ADC values were significantly different for benign and malignant nodules (p=0.02) with sensitivity and specificity of 70% and 63%, respectively, and receiver-operator-characteristic (ROC) area-under-the-curve (AUC) of 0.73. The LDA model of the top 21 textural features correctly classified 89/94 DW-MRI ROIs with 92% sensitivity, 96% specificity, and AUC of 0.97. This algorithm correctly classified 16/18 (89%) patients in the independently obtained test set of thyroid DW-MRI scans. Conclusion TA classifies thyroid nodules with high sensitivity and specificity on multi-institutional DW-MRI datasets. This method needs further validation in a larger prospective study.

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Section: Discussionsupporting

confidence: 62%

Multi‐institutional validation of a novel textural analysis tool for preoperative stratification of suspected thyroid tumors on diffusion‐weighted MRI

Brown

Nagala

McLean

et al. 2015

Magnetic Resonance in Med

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“…The b value of 500 s/mm 2 was used in our study to acquire DW-MR images with sufficient diffusion weighting and image quality. The b values used by other investigators (24,25,27,45) were in the range of 128*1000 s/mm 2 . From a clinical perspective, this pilot study suggests that DW-MRI could have clinical relevance in providing additional risk stratification information for small thyroid cancers that appear to be confined to the thyroid based on standard preoperative ultrasound and clinical evaluations.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, ADC value has shown potential as a surrogate imaging biomarker to assess tumor aggressiveness in breast (15), prostate (16)(17)(18), and rectal cancers (19). For thyroid cancers, DW-MRI has been applied in the assessment of thyroid nodules, especially for the differentiation of benign and malignant tumors (20)(21)(22)(23)(24)(25)(26)(27). The purpose of this study was to evaluate whether ADC calculated from DW-MRI data before surgery stratifies tumor aggressiveness as defined at surgical histopathology analysis in PTCs.…”

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confidence: 99%

Using Diffusion-Weighted MRI to Predict Aggressive Histological Features in Papillary Thyroid Carcinoma: A Novel Tool for Pre-Operative Risk Stratification in Thyroid Cancer

Moreira

Hatzoglou

et al. 2015

Thyroid

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Background: Initial management recommendations of papillary thyroid carcinoma (PTC) are very dependent on preoperative studies designed to evaluate the presence of PTC with aggressive features. The purpose of this study was to evaluate whether diffusion-weighted magnetic resonance imaging (DW-MRI) before surgery can be used as a tool to stratify tumor aggressiveness in patients with PTC. Methods: In this prospective study, 28 patients with PTC underwent DW-MRI studies on a three Tesla MR scanner prior to thyroidectomy. Due to image quality, 21 patients were finally suitable for further analysis. Apparent diffusion coefficients (ADCs) of normal thyroid tissues and PTCs for 21 patients were calculated. Tumor aggressiveness was defined by surgical histopathology. The Mann-Whitney U test was used to compare the difference in ADCs among groups of normal thyroid tissues and PTCs with and without features of tumor aggressiveness. Receiver operating characteristic (ROC) analysis was performed to assess the discriminative specificity, sensitivity, and accuracy of and determine the cutoff value for the ADC in stratifying PTCs with tumor aggressiveness. Results: There was no significant difference in ADC values between normal thyroid tissues and PTCs. However, ADC values of PTCs with extrathyroidal extension (ETE; 1.53 -0.25 · 10 -3 mm 2 /s) were significantly lower than corresponding values from PTCs without ETE (2.37 -0.67 · 10 -3 mm 2 /s; p < 0.005). ADC values identified 3 papillary carcinoma patients with extrathyroidal extension that would have otherwise been candidates for observation based on ultrasound evaluations. The cutoff value of ADC to discriminate PTCs with and without ETE was determined at 1.85 · 10 -3 mm 2 /s with a sensitivity of 85%, specificity of 85%, and ROC curve area of 0.85. Conclusion: ADC value derived from DW-MRI before surgery has the potential to stratify ETE in patients with PTCs.

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“…They found that the ranges of the ADC values (b-value: 800) for carcinoma were 2.43-3.037 Â 10 À3 mm 2 /s, adenoma 1.626-2.233 Â 10 À3 mm 2 /s, and normal parenchyma 1.253-1.602 Â 10 À3 mm 2 /s and showed no overlap. When an ADC value of 2.25 or higher was used for predicting malignancy, the highest accuracy was 88%, with 85% sensitivity and 100% specificity (21). According to another report (22) of ADC values of 35 cold solitary nodules, the median ADC values for carcinoma and adenoma were 2.73 Â 10 À3 mm 2 /s and 1.93 Â 10 À3 mm 2 /s, respectively.…”

Section: Discussionmentioning

confidence: 99%

Diffusion‐weighted images differentiate benign from malignant thyroid nodules

Erdem

Muammer

et al. 2009

Magnetic Resonance Imaging

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Purpose:To reveal the possible role of diffusion-weighted images (DWI) in the differential diagnosis of benign and malignant thyroid nodules by comparing the results of fine-needle aspiration cytology (FNAC). Materials and Methods:In an 18-month period (December 2005 to May 2007), 27 cases with benign thyroid nodules with a total of 52 benign nodules, nine cases with thyroid gland malignancy, and 24 healthy control cases were included in the study. Cases that were indicated to undergo to FNAC examination and sent by a clinician for biopsy to the radiology unit were included in the study to assess the cytopathologic confirmation of the clinic, ultrasonographic, and magnetic resonance imaging (MRI) findings. Results:The mean apparent diffusion coefficient (ADC) values of thyroid nodules were 2745.3 6 601.1 Â 10 À6 mm 2 /s (1605-3899 Â 10 À6 mm 2 /s) in the benign group and 695.2 6 312.5 Â 10 À6 mm 2 /s (165-1330 Â 10 À6 mm 2 /s) in the malignant group. Normal thyroid tissues had mean ADC values of 1344.1 6 276.4 Â 10 À6 mm 2 /s (1015-1764 Â 10 À6 mm 2 /s). The ADC values of three subgroups were significantly different (P ¼ 0.0001). A reduced ADC was observed in most types of malignant tumors due to the consequent decrease of the extracellular extravascular space. Conclusion:Our preliminary results showed that ADC values of nodules may provide useful data about the nature of a thyroid nodule.

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Can Quantitative Diffusion-Weighted MR Imaging Differentiate Benign and Malignant Cold Thyroid Nodules? Initial Results in 25 Patients

Cited by 65 publications

References 28 publications

Multi‐institutional validation of a novel textural analysis tool for preoperative stratification of suspected thyroid tumors on diffusion‐weighted MRI

Multi‐institutional validation of a novel textural analysis tool for preoperative stratification of suspected thyroid tumors on diffusion‐weighted MRI

Using Diffusion-Weighted MRI to Predict Aggressive Histological Features in Papillary Thyroid Carcinoma: A Novel Tool for Pre-Operative Risk Stratification in Thyroid Cancer

Diffusion‐weighted images differentiate benign from malignant thyroid nodules

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