Prospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2022; 10(24): 8587-8598
Published online Aug 26, 2022. doi: 10.12998/wjcc.v10.i24.8587
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
Xiang Zhu, Jia Wang, Yan-Chun Wang, Ze-Feng Zhu, Jun Han, Department of Radiology, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
Jian Tang, Department of Head and Neck Surgery, the First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
Xiao-Wei Wen, Ying Fang, Department of Pathology, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
Author contributions: Zhu X and Han J designed the research study; Wang J and Wang YC performed the research; Zhu ZF and Tang J contributed software and formal analysis; Wen XW and Fang Y analyzed the data; Zhu X and Han J wrote the manuscript; all authors have read and approve the final manuscript.
Supported by the Health Commission of Zhejiang Province, No. 2019KY690.
Institutional review board statement: The study was reviewed and approved by the First Hospital of Jiaxing Research and Ethics Committee [(Approval No.2017-226)].
Clinical trial registration statement: The clinical trial is registered with Chinese Clinical Trial Registry, using identifier ChiCTR2200061944. Details can be found at http://www.chictr.org.cn/index.aspx.
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: All the authors declare no conflict of interest.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT Statement—checklist of items, and the manuscript was prepared and revised according to the CONSORT Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun Han, MD, Associate Chief Physician, Department of Radiology, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing 314000, Zhejiang Province, China. 13706735435@163.com
Received: September 10, 2021
Peer-review started: September 10, 2021
First decision: January 18, 2022
Revised: January 25, 2022
Accepted: July 19, 2022
Article in press: July 19, 2022
Published online: August 26, 2022
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: Thyroid nodule, Magnetic resonance imaging, Diffusion-weighted imaging, Quantitative study, Sensitivity, Specificity

Core Tip: Multiple diffusion coefficient parameters obtained by fitting with mono-exponential, bi-exponential, stretched exponential, and kurtosis diffusion-weighted imaging models are feasible techniques for investigating thyroid nodules; The metrics including D, distributed diffusion coefficient, Dapp and Kapp provide additional information with similar diagnostic performance of ADC, and combination of these metrics may contribute to differentiate benign and malignant thyroid nodules; The apparent diffusion coefficient calculated with a mono-exponential model using a single pair of conventional b values (b = 1000 s/mm2) have similar diagnostic performance to those calculated with higher b values (b value > 1000 s/mm2).