Role of multi-modality functional imaging in differentiation between benign and malignant thyroid 18F-fluorodeoxyglucose incidentaloma

• H. Shi ^[1] ; Z. Yuan ^[2] ; C. Yang ^[1] ; J. Zhang ^[1] ; C. Liu ^[1] ; J. Sun ^[1] ; X. Ye ^[3]
  1. [1] Shanghai Universal Medical Imaging Diagnostic Center, People’s Republic of China
  2. [2] Department of Radiology, PET/CT Center, Shanghai 85 hospital. People’s Republic of China
  3. [3] Department of Radiology, Shanghai Chest Hospital, Shanghai Jiaotong University. People’s Republic of China

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 21, Nº. 11, 2019, págs. 1561-1567
• Idioma: inglés
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• Resumen

  • Purpose To evaluate the diagnostic performance of multi-modality functional imaging in differentiating malignant and benign thyroid 18F-fluorodeoxyglucose (18F-FDG) incidentaloma.

    Methods This study included 87 patients with thyroid 18F-FDG incidentalomas detected by 18F-FDG- positron emission tomography/computed tomography (18F-FDG-PET/CT) and diagnosed at surgery or biopsy, who received 18F-FDG-PET/CT, diffusion-weighted MR imaging (DWI) and ultrasound elastography (USE). The metabolic tumor volume (MTV), total lesion glycolysis (TLG), apparent diffusion coefficient (ADC) values and ultrasound elasticity scores of thyroid 18F-FDG incidentalomas were measured and compared in benign and malignant thyroid incidentalomas. The differences of malignant and benign thyroid incidentalomas were tested by χ2 test, Fisher’s exact test, t test, or Mann–Whitney U test. The diagnostic performance was evaluated and optimal cut-off values were determined in distinguishing malignant from benign thyroid incidentalomas by receiver operating characteristic curve analysis.

    Results MTV, TLG and USE scores of malignant thyroid incidentalomas were significantly higher than benign; but ADC value was significantly lower. We defined the functional imaging parameters TLG < 2.48, ADC > 1.80 × 10−3mm2/s, and USE score of 1 as markers of benign thyroid incidentalomas and each scored -1 point; TLG ≥ 2.48, ADC ≤ 1.80 × 10−3mm2/s, and USE score of 4 as markers of malignancy and each scored 1 point. Combined multi-functional imaging parameters achieved the highest performance (84.6% sensitivity and 97.1% specificity) for distinguish malignant from benign thyroid incidentaloma with AUC 0.957 (95% CI 0.917, 0.997).

    Conclusions Functional imaging might help to distinguishing malignant from benign thyroid 18F-FDG incidentalomas, and combined multi-functional imaging parameters could improve it.