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Research ArticleHead and Neck Imaging

Role of Apparent Diffusion Coefficient Values in Differentiation Between Malignant and Benign Solitary Thyroid Nodules

A.A.K. Abdel Razek, A.G. Sadek, O.R. Kombar, T.E. Elmahdy and N. Nada
American Journal of Neuroradiology March 2008, 29 (3) 563-568; DOI: https://doi.org/10.3174/ajnr.A0849
A.A.K. Abdel Razek
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A.G. Sadek
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O.R. Kombar
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T.E. Elmahdy
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N. Nada
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    Fig 1.

    Measurement of the ADC value of a thyroid nodule in an ADC map image. The region of interest is drawn around the thyroid nodule, and the ADC value is measured.

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    Fig 2.

    Adenomatous nodule. A–C, Axial T1- and T2-weighted and coronal T1-weighted MR images of the neck, respectively, showing a well-defined oval mainly solid solitary nodule (arrow) affecting the right thyroid lobe with contralateral tracheal displacement. D, An ADC map image with hyperintensity of the nodule (arrow) denoting increased diffusion and a measured ADC value of 1.57 ± 0.11 × 10−3 mm2/s.

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    Fig 3.

    Follicular adenoma. A and B, Axial T1- and T2-weighted MR images, respectively, showing a well-defined more or less oval solitary nodule affecting the right thyroid lobe with contralateral tracheal displacement. The nodule has an anterior cystic part (arrow) and another posterior solid one (arrowhead). C, An ADC map image with marked hyperintensity of the anterior cystic portion of the nodule (arrow), denotes increased diffusion with a measured ADC value of 2.25 ± 0.18 × 10−3 mm2/s and a relatively hypointense posterior solid portion (arrowhead), denotes relatively restricted diffusion with a measured ADC value of 1.2 ± 0.08 × 10−3 mm2/s.

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    Fig 4.

    Thyroid cyst. A–C, Axial T1- and T2-weighted and coronal T1-weighted MR images, respectively, showing a well-defined more or less oval solitary nodule (arrow) affecting the right thyroid lobe. D, An ADC map image with marked hyperintensity of the nodule (arrow) denoting increased diffusion, and the measured ADC value is 2.05 ± 0.13 × 10−3 mm2/s.

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    Fig 5.

    Hemorrhagic thyroid cyst. A and B, Axial T1- and T2-weighted MR images, respectively, showing a small well-defined more or less rounded solitary nodule (arrow) affecting the right thyroid lobe. The nodule is hyperintense on both T1- and T2-weighted images. C, An ADC map image shows low signal intensity of the nodule. The measured ADC value is 0.5 ± 0.07 × 10−3 mm2/s.

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    Fig 6.

    Papillary carcinoma of the thyroid. A and B, Axial T1- and T2-weighted MR images, respectively, showing a well-defined irregular mainly solid solitary nodule (arrow) involving all the right thyroid lobe with contralateral tracheal displacement. C, ADC map image shows hypointensity of the nodule (arrow). The measured ADC value is 0.97 ± 0.1 × 10−3 mm2/s.

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    Fig 7.

    Follicular carcinoma of the thyroid. A and B, Axial T1- and T2-weighted MR images, respectively, showing a well-defined more or less oval mainly solid solitary nodule (arrowheads) affecting the right thyroid lobe with contralateral tracheal displacement. C, ADC map image shows a low ADC value (0.92 ± 0.06 × 10−3 mm2/s) of the thyroid nodule (arrowhead).

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    Fig 8.

    ROC curve of the ADC value used for differentiation of benign from malignant solitary thyroid nodules. The area under the curve measures 97%.

Tables

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    Table 1:

    The ADC values of solitary thyroid nodules in 63 patients

    Type of Thyroid NodulesNo. (%) of Thyroid NodulesRange of ADC Values (mm2/s)Mean ADC Values (mm2/s)
    Benign56 (88.9 )0.5–2.3 × 10−31.8 ± 0.27 × 10−3
        Adenomatous nodule42 (66.7)1.1–1.9 × 10−31.8 ± 0.14 × 10−3
        Follicular adenoma6 (9.5)1.2–2 × 10−31.7 ± 0.17 × 10−3
        Thyroid cyst8 (12.7)0.5–2.3 × 10−31.9 ± 0.38 × 10−3
    Malignant7 (11.1)0.5–1.1 × 10−30.73 ± 0.19 × 10−3
        Papillary carcinoma4 (6.3)0.5–1.1 × 10−30.68 ± 0.23 × 10−3
        Follicular carcinoma3 (4.8)0.6–1 × 10−30.77 ± 0.17 × 10−3
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    Table 2:

    Comparison between the ADC values of benign and malignant solitary thyroid nodules

    Pathology of Thyroid NoduleNo. (%) of Thyroid NodulesMean ADC Values (mm2/s)P Value*
    Benign56 (88.9)1.8 ± 0.27 × 10−3.0001
    Malignant7 (11.1)0.73 ± 0.19 × 10−3
    • * Significance was considered when P <.05.

    • View popup
    Table 3:

    Comparison between the ADC values in the different subtypes of benign and malignant solitary thyroid nodules

    Type of Thyroid NoduleNo. (%) of Thyroid NodulesMean ADC Values (mm2/s)P Value*
    Benign
        Adenomatous nodule42 (66.7)1.8 ± 0.14 × 10−3
        Follicular adenoma6 (9.5)1.7 ± 0.17 × 10−3.0001
        Thyroid cyst8 (12.7)1.9 ± 0.38 × 10−3
    Malignant
        Papillary carcinoma4 (6.3)0.68 ± 0.23 × 10−3.464
        Follicular carcinoma3 (4.8)0.77 ± 0.17 × 10−3
    • * Significance was considered when P < .05.

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American Journal of Neuroradiology: 29 (3)
American Journal of Neuroradiology
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A.A.K. Abdel Razek, A.G. Sadek, O.R. Kombar, T.E. Elmahdy, N. Nada
Role of Apparent Diffusion Coefficient Values in Differentiation Between Malignant and Benign Solitary Thyroid Nodules
American Journal of Neuroradiology Mar 2008, 29 (3) 563-568; DOI: 10.3174/ajnr.A0849

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Role of Apparent Diffusion Coefficient Values in Differentiation Between Malignant and Benign Solitary Thyroid Nodules
A.A.K. Abdel Razek, A.G. Sadek, O.R. Kombar, T.E. Elmahdy, N. Nada
American Journal of Neuroradiology Mar 2008, 29 (3) 563-568; DOI: 10.3174/ajnr.A0849
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