Quantitative differentiation of malignant and benign thyroid nodules with multi-parameter diffusion-weighted imaging

Xiang Zhu; Jia Wang; Yan-Chun Wang; Ze-Feng Zhu; Jian Tang; Xiao-Wei Wen; Ying Fang; Jun Han

doi:10.12998/wjcc.v10.i24.8587

Quantitative differentiation of malignant and benign thyroid nodules with multi-parameter diffusion-weighted imaging

World J Clin Cases. 2022 Aug 26;10(24):8587-8598. doi: 10.12998/wjcc.v10.i24.8587.

Authors

Xiang Zhu¹, Jia Wang¹, Yan-Chun Wang¹, Ze-Feng Zhu¹, Jian Tang², Xiao-Wei Wen³, Ying Fang³, Jun Han⁴

Affiliations

¹ Department of Radiology, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China.
² Department of Head and Neck Surgery, the First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China.
³ Department of Pathology, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China.
⁴ Department of Radiology, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China. 13706735435@163.com.

Abstract

Background: The value of conventional magnetic resonance imaging in the differential diagnosis of thyroid nodules is limited; however, the value of multi-parameter diffusion-weighted imaging (DWI) in the quantitative evaluation of thyroid nodules has not been well determined.

Aim: To determine the utility of multi-parametric DWI including mono-exponential, bi-exponential, stretched exponential, and kurtosis models for the differentiation of thyroid lesions.

Methods: Seventy-nine patients (62 with benign and 17 with malignant nodules) underwent multi-b value diffusion-weighted imaging of the thyroid. Multiple DWI parameters were obtained for statistical analysis.

Results: Good agreement was found for diffusion parameters of thyroid nodules. Malignant lesions displayed lower diffusion parameters including apparent diffusion coefficient (ADC), the true diffusion coefficient (D), the perfusion fraction (f), the distributed diffusion coefficient (DDC), the intravoxel water diffusion heterogeneity (α) and kurtosis model-derived ADC (Dapp), and higher apparent diffusional kurtosis (Kapp) than benign entities (all P < 0.01), except for the pseudodiffusion coefficient (D*) (P > 0.05). The area under the ROC curve (AUC) of the ADC_{(0 and 1000)} was not significantly different from that of the ADC_{(0 and 2000)}, ADC_{(0 to 2000)}, ADC_{(0 to 1000)}, D, DDC, Dapp and Kapp (all P > 0.05), but was significantly higher than the AUC of D*, f and α (all P < 0.05) for differentiating benign from malignant lesions.

Conclusion: Multiple DWI parameters including ADC, D, f, DDC, α, Dapp and Kapp could discriminate benign and malignant thyroid nodules. The metrics including D, DDC, Dapp and Kapp provide additional information with similar diagnostic performance of ADC, combination of these metrics may contribute to differentiate benign and malignant thyroid nodules. The ADC calculated with higher b values may not lead to improved diagnostic performance.

Keywords: Diffusion-weighted imaging; Magnetic resonance imaging; Quantitative study; Sensitivity; Specificity; Thyroid nodule.