Characterization of Thyroid Nodules by 4-Dimensional Computed Tomography

Fitzgerald, Ryan T.; Kuruva, Manohar; David, Ryan; Samant, Rohan; Kumar, Manoj; Hemert, Rudy Van; Angtuaco, Edgardo J.; Bodenner, Donald; Stack, Brendan C.

doi:10.1097/rct.0000000000000495

Cited by 8 publications

(11 citation statements)

References 23 publications

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“…Thyroid nodularity is reported to be an independent factor associated with discordance between 4DCT and intraoperative findings 18 . Thyroid nodules may be more hypoattenuating than the rest of the thyroid and can have overlapping wash‐in and washout characteristics with parathyroid lesions, making identification of juxta‐thyroid and intrathyroid parathyroid lesions difficult 19 . We believe the intrathyroid location in the background of multinodular thyroid disease in our patient accounted for the failure to identify the lesion on 2DCT.…”

Section: Discussionmentioning

confidence: 73%

Percentage arterial enhancement on 2D CT in the diagnosis of primary hyperparathyroidism: A prospective validation study and potential pitfalls

et al. 2022

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Background: Parathyroid lesions are identified by subjective enhancement and washout patterns on computed tomography (CT). We have previously proposed "percentage arterial enhancement" (PAE) as an objective index and now aim to validate its performance prospectively.Methods: Dual-phase CT was performed in 40 consecutive primary hyperparathyroidism patients. PAE was calculated as [{arterial phase Hounsfield unit (HU)-unenhanced phase HU}/unenhanced phase HU] Â 100. PAE > 128.9% was considered parathyroid.Results: PAE had 94.2% sensitivity, 100% positive predictive value (PPV) in lateralization, and sensitivity and PPV of 93.9% in quadrant localization of singlegland disease. PAE failed to identify two lesions: an intrathyroidal parathyroid carcinoma in the background of multinodular goiter and another lower enhancing cystic parathyroid adenoma. PAE had 60% sensitivity, and 100% PPV to identify multigland disease. The mean effective dose was 2.74 mSV.Conclusions: PAE is a specific CT index for parathyroid lesions with less radiation exposure. Areas of caution include intrathyroidal and cystic lesions.

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Section: Discussionmentioning

confidence: 73%

Percentage arterial enhancement on 2D CT in the diagnosis of primary hyperparathyroidism: A prospective validation study and potential pitfalls

et al. 2022

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“…Similarly, Hunter et al 17 found washout of enhancement of thyroid tissue and parathyroid adenomas in the delayed (55 seconds) and late (100 seconds) phases. Fitzgerald et al 23 found no significant difference in Hounsfield unit values between the benign (74 HU) and malignant nodules (98 HU) in the delayed phase (P ¼ .3). Again, this difference is likely related to the inclusion of hyperdense thyroid tissue in the normal and diseased thyroid group in our study.…”

Section: Discussionmentioning

confidence: 91%

“…Ours and the study of Hunter et al also found the greatest separation between thyroid tissue and recurrence, and adenomas and thyroid tissue in the arterial phase, respectively. Fitzgerald et al 23 found no significant difference in HU values between the benign (128 HU) and malignant nodules (144 HU) in the arterial phase (P ¼ .7). Differences between their study and ours are likely related to the inclusion of normal thyroid tissue in the diseased thyroid group in our study, which would not be present in the thyroid nodules studied by Fitzgerald et al 23 In our study, there was washout of contrast in the delayed and late phases in all 3 studied groups.…”

Section: Discussionmentioning

confidence: 92%

“…Fitzgerald et al 23 found no significant difference in HU values between the benign (128 HU) and malignant nodules (144 HU) in the arterial phase (P ¼ .7). Differences between their study and ours are likely related to the inclusion of normal thyroid tissue in the diseased thyroid group in our study, which would not be present in the thyroid nodules studied by Fitzgerald et al 23 In our study, there was washout of contrast in the delayed and late phases in all 3 studied groups. Similarly, Hunter et al 17 found washout of enhancement of thyroid tissue and parathyroid adenomas in the delayed (55 seconds) and late (100 seconds) phases.…”

Section: Discussionmentioning

confidence: 92%

“…They noted that the higher density of the thyroid gland in the "precontrast phase [as this phase] allows distinction between the iodine-rich thyroid and the surrounding tissue." Fitzgerald et al 23 studied the 4D-MDCT patterns of benign and malignant thyroid nodules. Their results in the precontrast phase were similar to ours because the precontrast attenuation of malignant nodules was significantly lower than that of benign lesions (36 versus 61 HU, P ¼ .05).…”

Section: Discussionmentioning

confidence: 99%

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Distinguishing Recurrent Thyroid Cancer from Residual Nonmalignant Thyroid Tissue Using Multiphasic Multidetector CT

Debnam¹,

Guha-Thakurta²,

Sun³

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: During thyroidectomy incomplete resection of the thyroid gland may occur. This complicates the imaging surveillance of these patients as residual thyroid needs to be distinguished from local recurrence. Therefore, the purpose of this study was to determine if multiphasic multi-detector computed tomography (4D-MDCT) can differentiate residual nonmalignant thyroid tissue and recurrent thyroid carcinoma after thyroidectomy. MATERIALS AND METHODS: In this retrospective study, Hounsfield unit values on multiphasic multidetector CT in precontrast, arterial (25 seconds), venous (55 seconds), and delayed (85 seconds) phases were compared in 29 lesions of recurrent thyroid cancer, 29 with normal thyroid, and 29 with diseased thyroid (thyroiditis/multinodular thyroid). The comparison of Hounsfield unit values among lesion types by phase was performed using ANOVA. The performance of Hounsfield unit values to predict recurrence was evaluated by logistic regression and receiver operating characteristic analysis. RESULTS: All 3 tissue types had near-parallel enhancement characteristics, with a wash-in-washout pattern. Statistically different Hounsfield unit density was noted between the recurrence (lowest Hounsfield unit), diseased (intermediate Hounsfield unit), and normal (highest Hounsfield unit) thyroid groups throughout all 4 phases (P , .001 for each group and in each phase). Dichotomized recurrenceversus-diseased/normal thyroid tissue with univariate logistic regression analysis demonstrated that the area under the receiver operating characteristic curve for differentiating benign from malignant thyroid for the various phases of enhancement was greatest in the precontrast phase at 0.983 (95% CI, 0.954-1), with a cutoff value of #62 (sensitivity/specificity, 0.966/0.983) followed by the arterial phase. CONCLUSIONS: Recurrent thyroid carcinoma can be distinguished from residual nonmalignant thyroid tissue using multiphasic multidetector CT with high accuracy. The maximum information for discrimination is in the precontrast images, then the arterial phase. An optimal clinical protocol could be built from any number of phases but should include a precontrast phase.

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Intrathyroidal parathyroid adenomas: Scoping review on clinical presentation, preoperative localization, and surgical treatment

et al. 2022

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Intrathyroidal parathyroid adenomas (IPAs) are a rare cause of primary hyperparathyroidism. They are often difficult to localize preoperatively and intraoperatively, making diagnosis and treatment challenging. Current data on IPAs are sparse and fragmented in the literature. This makes it difficult to compare the effectiveness of different imaging and surgical techniques. To address this issue, this scoping review maps the literature on IPAs, focusing on four domains: clinical presentation, current localization methods, different surgical techniques, and histopathological features. A search of MEDLINE, Embase, and the Cochrane Library was conducted, with 19 studies meeting the inclusion criteria. The characteristics of IPAs on ultrasound, fine‐needle aspiration, CT, MRI, sestamibi‐based techniques, and selective venous sampling are summarized. Emerging imaging modalities, including autofluorescence, are introduced. Surgical methods and intraoperative factors that correlate with high success rates for removal are highlighted. This review also identifies gaps in knowledge to guide further research into this area.

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Characterization of Thyroid Nodules by 4-Dimensional Computed Tomography

Abstract: Our initial experience with a small group of patients was unable to support the use of 4DCT for characterizing thyroid nodules; however, precontrast nodule attenuation was significantly lower in malignant nodules when compared with benign nodules.

Cited by 8 publications

References 23 publications

Percentage arterial enhancement on 2D CT in the diagnosis of primary hyperparathyroidism: A prospective validation study and potential pitfalls

Percentage arterial enhancement on 2D CT in the diagnosis of primary hyperparathyroidism: A prospective validation study and potential pitfalls

Distinguishing Recurrent Thyroid Cancer from Residual Nonmalignant Thyroid Tissue Using Multiphasic Multidetector CT

Intrathyroidal parathyroid adenomas: Scoping review on clinical presentation, preoperative localization, and surgical treatment

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