Ömer ÖZÇAĞLAYAN, Tuğba İlkem KURTOĞLU ÖZÇAĞLAYAN, Ahmet Mesrur HALEFOĞLU

Tiroid Nodüllerinde Malign ve Benign Ayrımında Difüzyon Ağırlıklı Manyetik Rezonans İncelemenin Yeri

Öz Amaç: Bu çalışmanın amacı, Difüzyon Ağırlıklı Manyetik Rezonans Görüntülemenin (DAMRG) tiroid nodüllerinde malign-benign ayrımındaki yerini araştırmak olacaktır. Material-Metot: Çalışmaya tiroid nodülü ve patolojik tanısı olan 39 hasta ve 40 nodül dahil edildi. İzlenen nodüller, DAMRG ile incelendi ve elde edilen Apparent Diffusion Coefficient (ADC) değerleri ve patolojik sonuçlar arasındaki ilişki istatistiksel olarak değerlendirildi. Bulgular: Nodüllerin 9’u malign, 31’i benign karakterdeydi. Malign ve benign nodüllerin ortalama ADC değerleri sırasıyla (1,60±0,29)x10⁻³ sn/mm²)ve (2,14±0,39)x10⁻³ sn/mm²) bulundu. Malign ve benign ADC değerleri arasında anlamlı istatistiksel farklılık izlendi (p<0,001). Receiver Operator Coefficient (ROC) analizi ile malign nodüllerde cut-off değer 1,67x10⁻³ sn/mm² olarak hesaplandı. Sonuç: ADC değerleri , benign ve malign tiroid nodüllerini ayırmak için non-invaziv bir tanı metodu olarak kullanılabilir. Abstract Objective: The aim of this study was to investigate the role of the Diffusion Weighted Imaging (DWI) sequences of Magnetic Resonance Imaging (MR) in diagnosis of malignant and benign nodules of thyroid nodules. Matherial/Method: Thirty nine patients and fourty nodules were enrolled to the study. The observed nodules were examined with DWI. Relationship between obtained Apparent Diffusion Coefficient (ADC) values and pathological results were statistically evaluated. Results: There were 9 malignant and 31 benign nodules. Mean ADC values were evaluated (1.60±0.29)x10⁻³ sn/mm² for malignant nodules , and (2.14±0.39)x10⁻³ sn/mm²) for benign nodules, respectively. There was a statistical difference between ADC values of malignant and benign nodules (p<0.001). The ADC cut-off value of malignant nodules was evaluated 1.67x10⁻³ sn/mm² with Receiver Operator Coefficient (ROC) analysis. Conclusion: ADC values might be used as a non-invasive diagnostic tool for discriminating the malignant and benign thyroid nodules.

Anahtar Kelimeler:

difüzyon ağırlıklı MRG, tiroid nodülü, kanser

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1) Moon WJ, Jung SL, Lee JH, Na DG, Baek JH, Lee YH, Kim J, Kim HS, Byun JS, Lee DH; Thyroid Study Group, Korean Society of Neuro- and Head and Neck Radiology.Benign and malignant thyroid nodules: US differentiation--multicenter retrospective study.Radiology. 2008 Jun;247(3):762-70.2)Yang J, Schnadig V, Logrono R, Wasserman PG.Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations.Cancer. 2007 Oct 25;111(5):306-15.3)Koh DM, Collins DJ.Diffusion-weighted MRI in the body: applications and challenges in oncology.American Journal of Roentgenology. 2007;188: 1622-1635.4) Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, Cronan JJ, Doubilet PM, Evans DB, Goellner JR, Hay ID, Hertzberg BS, Intenzo CM, Jeffrey RB, Langer JE, Larsen PR, Mandel SJ, Middleton WD, Reading CC, Sherman SI, Tessler FN; Society of Radiologists in Ultrasound.Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement.Radiology. 2005 Dec;237(3):794-800.5)Dean DS, Gharib H.Epidemiology of thyroid nodules.Best Pract Res Clin Endocrinol Metab. 2008 Dec;22(6):901-11.6) Hegedus L. The thyroid nodule.N Engl J Med 2004; 351:1764-1771.7)Wong KT, Ahuja AT.Ultrasound of thyroid cancer.Cancer Imaging. 2005 Dec 9;(5):157-66.8) Gharib H.Fine-needle aspiration biopsy of thyroid nodules: advantages, limitations, and effect.Mayo Clin Proc. 1994 Jan;69(1):44-9.9)Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Sherman SI, Tuttle RM; American Thyroid Association Guidelines Taskforce.Management guidelines for patients with thyroid nodules and differentiated thyroid cancer.Thyroid. 2006 Feb;16(2):109-42.10)Tollin SR, Mery GM, Jelveh N, Fallon EF, Mikhail M, Blumenfeld W, Perlmutter S.The use of fine-needle aspiration biopsy under ultrasound guidance to assess the risk of malignancy in patients with a multinodular goiter.Thyroid. 2000 Mar;10(3):235-41.11)Shetty SK, Maher MM, Hahn PF, Halpern EF, Aquino SL.Significance of incidental thyroid lesions detected on CT: correlation among CT, sonography, and pathology.AJR Am J Roentgenol. 2006 Nov;187(5):1349-56.12) Burke JS, Butler JJ, Fuller LM.Malignant lymphomas of the thyroid: a clinical pathologic study of 35 patients including ultrastructural observations.Cancer. 1977 Apr;39(4):1587-602.13)Radecki PD, Arger PH, Arenson RL, Jennings AS, Coleman BG, Mintz MC, Kressel HY.Thyroid imaging: comparison of high-resolution real-time ultrasound and computed tomography.Radiology. 1984 Oct;153(1):145-7.14) Higgins CB, McNamara MT, Fisher MR, Clark OH. MR imaging of the thyroid. AJR Am J Roentgenol. 1986 Dec;147(6):1255-61.15) Schaefer PW, Grant PE, Gonzalez RG.Diffusion-weighted MR imaging of the brain.Radiology. 2000 Nov;217(2):331-45.16) Razek AA,Sadek AG,Kombar OR, Elmahdy TE, Nada N. Role of apparent diffusion coeffi- cient values in differentiation between malig- nant and benign solitary thyroid nodules. AJNR Am J Neuroradiol 2008;29(3):563-8. 17) Schueller-Weidekamm C, Kaserer K, Schueller G, Scheuba C, Ringl H, Weber M, et al. Can quantitative diffusion-weighted MR imaging differentiate benign and malignant cold nodules? Initial results in 25 patients. AJNR Am J Neuroradiol 2009;30(2):417-22.18)Bozgeyik Z, Coskun S, Dagli AF, Ozkan Y, Sahpaz F, Ogur E. Diffusion-weighted MR im- aging of thyroid nodules. Neuroradiology 2009;51(3):193-8. 19) Erdem G, Erdem T, Muammer H, Mutlu DY, Firat AK, Sahin I, et al. Diffusion-weighted images differentiate benign from malignant thyroid nodules. J Mag Reson Imaging 2010;31(1):94-100. 20) Cova M, Squillaci E, Stacul F, Manenti G, Gava S, Simonetti G, Pozzi-Mucelli R.Diffusion-weighted MRI in the evaluation of renal lesions: preliminary results.Br J Radiol. 2004 Oct;77(922):851-7.