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  • Title: Diagnostic value of dynamic contrast medium enhanced magnetic resonance imaging in preoperative detection of thyroid carcinoma.
    Author: Tezelman S, Giles Y, Tunca F, Gok K, Poyanli A, Salmaslioglu A, Terzioglu T.
    Journal: Arch Surg; 2007 Nov; 142(11):1036-41. PubMed ID: 18025330.
    Abstract:
    OBJECTIVE: To assess the diagnostic value of dynamic contrast medium-enhanced magnetic resonance imaging (DCE-MRI) in detection of thyroid carcinoma compared with fine-needle aspiration biopsy and frozen section analysis in multinodular goiter. DESIGN: Prospective clinical study. SETTING: University hospital. PATIENTS: Thirty consecutive patients with nodular goiter without any clinical risk and symptoms associated with thyroid carcinoma were studied. Twenty-five patients had euthyroid multinodular goiter, and 5 had toxic nodular goiter. Scintigraphy, ultrasonography, and DCE-MRI were performed preoperatively in all patients, as well as fine-needle aspiration biopsy and frozen section analysis in 17 patients with dominant cold nodules. MAIN OUTCOME MEASURES: Contrast enhancement patterns on DCE-MRIs and histopathologic results of thyroidectomy specimens were correlated. The sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values of DCE-MRI and the results of fine-needle aspiration biopsy and preoperative frozen section analysis to detect thyroid carcinoma were compared. RESULTS: Thyroid carcinoma was found in 11 patients (36.7%), but was clinically significant in only 4 (13.3%). Delayed washout pattern of contrast enhancement significantly correlated with a histologic diagnosis of thyroid carcinoma (P < .001). The conditional probability of thyroid cancer in a patient with multinodular goiter with a delayed washout pattern was 0.78. The sensitivity and diagnostic accuracy of DCE-MRI to detect thyroid carcinoma was higher compared with fine-needle aspiration biopsy and frozen section analysis (100% vs 50% and 85.7%, and 90% vs 70.6% and 87.5%, respectively). The negative predictive value of DCE- MRI was 100%, ruling out thyroid carcinoma in all patients with benign goiter. CONCLUSION: Dynamic contrast-enhanced magnetic resonance imaging is useful to detect or exclude thyroid carcinoma with high diagnostic accuracy in patients with multinodular goiter when results of other diagnostic methods are inconclusive.
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