Preoperative Prediction Of The Extrathyroidal Extension Of Papillary Thyroid Carcinoma Using Ultrasonography And MRI

Part? Preoperative prediction of the extrathyroidal extension of papillary thyroid carcinoma using ultrasonography and MRIOBJECTIVE:The purpose of the present study was to evaluate the diagnostic performance of preoperative ultrasonography(US)and magnetic resonance imaging(MRI)for the prediction of extrathyroidal extension(ETE)in patients with papillary thyroid carcinoma(PTC)and to compare the diagnostic performances of US and MRI for predicting ETE.METHODS:Between February 2014 and January 2017,98 consecutive patients underwent surgery for pathologically confirmed PTCs.We analyzed the medical records of all patients with PTC with preoperative US?MRI?combination of US and MRI scan to calculate the accuracy of minimal ETE,extensive ETE and total ETE(minimal & extensive);We analyzed the medical records of all patients with PTC with preoperative US,MRI scan to calculate the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)of minimal ETE,extensive ETE and total ETE(minimal & extensive)in postoperative pathologic examination.The diagnostic performances of US and MRI in the evaluation of ETE were compared using the ?2 test.RESULTS:For minimal ETE,the accuracy was92%(46/50)of US,74%(37/50)of MRI,the diagnostic accuracy of US was higher than that of MRI(92%/74%,p <0.05),and their combination was 98.0%(49/50),The difference of three methods for minimal ETE was statistically significant difference(p=0.001).For extensive ETE,the accuracy was56%(15 /27)of US,89%(24/27)of MRI,the diagnostic accuracy of MRI was higher than that of US(89%/56%,p <0.05),and their combination was96%(26/27).The difference of three methods for extensive ETE was statistically significant difference(p =0.000).For the total accuracy of total ETE,US was 79%(61/77),MRI was79%(61/77),and their combination was 97%(75/77).The difference of three methods for ETE was statistically significant difference(p =0.001).US was more sensitivity?NPV than MRI in the prediction of minimal ETE(92.0 %/80.0%,83.3%/ 69.7%,p <0.05)and MRI showed higher sensitivity than US in the prediction of extensive ETE(92.6 %/74.1%,p <0.05).MRI showed higher specificity than US in the prediction of total ETE(66.7 %/52.4%,p <0.05).CONCLUSION:US showed higher accuracy,sensitivity,NPV than MRI for assessing minimal ETE,and the diagnostic accuracy of their combination was higher.MRI showed higher accuracy,specificity than US for assessing extensive ETE,and the diagnostic accuracy of their combination was higher.MRI showed higher specificity than US for assessing total ETE,and the diagnostic accuracy of their combination was higher.The combination of US and MRI can improve the accuracy of ETE for PTC.Part ? Preoperative prediction of the extrathyroidal extension of papillary thyroid carcinoma using multi b values of MR Diffusion Weighted ImagingOBJECTIVE:The purpose of the present study was to evaluate the diagnostic performance of preoperative multi b values of DWI(diffusion-weighted imaging,DWI)and ADC(apparent diffusion coefficient)for the prediction of extrathyroidal extension(ETE)of PTC(papillary thyroid carcinoma).METHODS:Retrospectively the MRI scan,DCE-MRI(dynamic contrast-enhanced MR imaging,DCE)and DWI images of 106 patients were diagnosed as papillary thyroid carcinoma.Apparent diffuse coefficients(ADC)were measured on maps generated from DWI data of solid regions of tumors.Analysis total ETE(minimal ETE,extensive ETE),without ETE PTC solid regional difference of ADC values,find the different ADC values between total ETE(minimal ETE,extensive ETE)and without ETE PTC malignant solid tumor region.RESULTS:When b=500 s/mm2,ADC values of PTCs with ETE[(1.27±0.17)×10-3mm2/s]were significantly lower than corresponding values from PTCs without ETE [(2.12±0.72)×10-3mm2/s,P <0.05].ADC values of PTCs with extensive ETE[(1.23±0.17)×10-3mm2/s] were significantly lower than corresponding values from PTCs with minimal ETE[(1.29±0.16)×10-3mm2/s,p >0.05].When b=500 s/mm2,the cutoff value of ADC to discriminate PTCs with and without ETE was determined at 1.53×10–3 mm2/s with a sensitivity of 69%,specificity of 93.7%,positive predictive value of 77.6%,negative predictive were 77.5% and ROC curve area of 0.887.CONCLUSION:1.DWI-MRI contributes to the differential diagnosis of thyroid papillary carcinoma ETE.2.PTC with ETE area of the solid tumor ADC values significantly lower than PTC without ETE solid area ADC values.3.b= 500 s/mm2 is the best DWI image quality,PTC with ETE has obvious difference ADC values of PTC without ETE.