Tiroid Karsinomu Tanısı – Problem Çözücü Olarak Dinamik Manyetik Rezonans Görüntüleme

Yıl 2023, Cilt: 6 Sayı: 1, 13 - 18, 10.04.2023

Emrah Akay , Nezahat Erdoğan , Engin Uluç

https://doi.org/10.33713/egetbd.1209040

Öz

ÖZ

Amaç: Tiroid kanseri olgularının ayırıcı tanısında dinamik manyetik rezonans görüntülemenin (MRG) renkli Doppler US ve İnce İğne Aspirasyon Biyopsisi (İİAB) ile tanısal doğruluğunun karşılaştırılması.
Gereç ve yöntem: Çalışma grubu, muayenelerinde tiroid hormon bozuklukları olan 28 kadın ve 6 erkekten oluşuyordu. Toplam 38 nodül incelendi. Radyolojik incelemelerin ardından İİAB ve tiroidektomi uygulandı.
Sonuçlar: Dinamik MR'nin karsinom teşhisi için renkli-Doppler US, İİAB ve dinamik MR modaliteleri arasında en yüksek sensitivite ve spesifisiteye sahip olduğu bulundu. Dinamik MR incelemesinde, malign ve benign nodüller arasında, p < 0.05 düzeyinde hesaplanan tepe kontrast sinyal yoğunluğu değerleri (p = 0.018) ve minimum kontrastlı sinyal yoğunluğu değerleri (p = 0.023) arasındaki fark istatistiksel olarak anlamlıydı.
Sonuç: Dinamik MRG verilerinin analizi ile tiroid nodüllerinin ayırıcı tanısının yapılabileceğini düşünüyoruz. Malign tiroid nodülleri tipik zaman-sinyal yoğunluk eğrileri göstermekte olup, dinamik MRG'nin radyoloji-patoloji uyumsuzluğu gibi belirli durumlarda tiroid nodüllerinin ameliyat öncesi değerlendirilmesi için değerli olacabileceğine inanıyoruz.

Anahtar Kelimeler

dinamik MR, tiroid kanseri, doppler US

Diagnosis of Thyroid Carcinoma - Dynamic Magnetic Resonance Imaging as a Problem Solver

Öz

Objective: Comparison of the diagnostic accuracy of dynamic magnetic resonance imaging (MRI) with color Doppler US and Fine Needle Aspiration Cytology (FNAC) in the differential diagnosis of thyroid carcinoma cases.
Materials and methods: Study group comprised 28 women and 6 men and all of them had thyroid hormone disorders in their routine examinations. 38 nodules were examined. After radiologic examinations, FNAC and thyroidectomy were applied.
Results: The dynamic MR was found to have the highest sensitivity and specificity between the color-Doppler US, FNAC, and dynamic MR modalities for the diagnosis of carcinoma. In the dynamic MR examination, the difference between the peak-contrast signal intensity values (p = 0.018) and the minimum-contrast signal intensity values (p = 0.023) calculated at the p < 0.05 level were statistically significant between the malignant and benign nodules.
Conclusions: We consider that the differential diagnosis of thyroid nodules can be made by analyzing the dynamic MRI data. Malignant thyroid nodules show typical time-signal intensity curves, and we believe that dynamic MRI will be valuable for preoperative assessment of the thyroid nodules in certain conditions like radiology–pathology mismatch.

Anahtar Kelimeler

thyroid carcinoma, dynamic mri, doppler us

Kaynakça

• Misiakos EP. Cytopathologic diagnosis of fine needle aspiration biopsies of thyroid nodules. World J Clin Cases. 2016;4(2):38.
• Srinivas MNS, Amogh VN, Gautam MS, Prathyusha IS, Vikram NR, Retnam MK, et al. A Prospective Study to Evaluate the Reliability of Thyroid Imaging Reporting and Data System in Differentiation between Benign and Malignant Thyroid Lesions. J Clin Imaging Sci. 2016 Feb 26;6:5.
• Lacout A, Chevenet C, Salas J, Marcy PY. Thyroid Doppler US: Tips and tricks. J Med Imaging Radiat Oncol. 2016 Apr 1;60(2):210–5.
• Tezelman S. Diagnostic Value of Dynamic Contrast Medium–Enhanced Magnetic Resonance Imaging in Preoperative Detection of Thyroid Carcinoma. Archives of Surgery. 2007 Nov 1;142(11):1036.
• Kusunoki T, Murata K, Nishida S, Tomura T, Inoue M. Histopathological findings of human thyroid tumors and dynamic MRI. Auris Nasus Larynx. 2002 Oct;29(4):357–60.
• Yuan Y, Yue XH, Tao XF. The diagnostic value of dynamic contrast-enhanced MRI for thyroid tumors. Eur J Radiol. 2012 Nov;81(11):3313–8.
• Gupta S, Madoff DC. Image-Guided Percutaneous Needle Biopsy in Cancer Diagnosis and Staging. Tech Vasc Interv Radiol. 2007 Jun;10(2):88–101.
• Chammas MC, Gerhard R, Oliveira IRS de, Widman A, Barros N de, Durazzo M, et al. Thyroid nodules: Evaluation with power Doppler and duplex Doppler ultrasound. Otolaryngology–Head and Neck Surgery. 2005 Jun 17;132(6):874–82.
• Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, et al. New Sonographic Criteria for Recommending Fine-Needle Aspiration Biopsy of Nonpalpable Solid Nodules of the Thyroid. American Journal of Roentgenology. 2002 Mar;178(3):687–91.
• Rago T, Vitti P, Chiovato L, Mazzeo S, de Liperi A, Miccoli P, et al. Role of conventional ultrasonography and color flow-doppler sonography in predicting malignancy in “cold” thyroid nodules. Eur J Endocrinol. 1998 Jan 1;41–6.
• Frates MC, Benson CB, Doubilet PM, Cibas ES, Marqusee E. Can Color Doppler Sonography Aid in the Prediction of Malignancy of Thyroid Nodules? Journal of Ultrasound in Medicine. 2003 Feb;22(2):127–31.
• Song M, Yue Y, Guo J, Zuo L, Peng H, Chan Q, et al. Quantitative analyses of the correlation between dynamic contrast-enhanced MRI and intravoxel incoherent motion DWI in thyroid nodules [Internet]. Vol. 12, Am J Transl Res. 2020. Available from: www.ajtr.org
• Paudyal R, Lu Y, Hatzoglou V, Moreira A, Stambuk HE, Oh JH, et al. Dynamic contrast-enhanced MRI model selection for predicting tumor aggressiveness in papillary thyroid cancers. NMR Biomed. 2020 Jan 1;33(1).
• Wang H, Wei R, Liu W, Chen Y, Song B. Diagnostic efficacy of multiple MRI parameters in differentiating benign vs. malignant thyroid nodules. BMC Med Imaging. 2018 Dec 3;18(1).
• Ben-David E, Sadeghi N, Rezaei MK, Muradyan N, Brown D, Joshi A, et al. Semiquantitative and Quantitative Analyses of Dynamic Contrast-Enhanced Magnetic Resonance Imaging of Thyroid Nodules. J Comput Assist Tomogr. 2015;39(6):855–9.