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Huang J, Liu D, Chen J, Wang X, Tang L, Zhang J, Tan Y, Lan X, Yin T, Nickel D, Wu J, Zhang J. Differential diagnosis of thyroid nodules by DCE-MRI based on compressed sensing volumetric interpolated breath-hold examination: A feasibility study. Magn Reson Imaging 2024; 111:138-147. [PMID: 38729225 DOI: 10.1016/j.mri.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVES To explore the potential and performance of quantitative and semi-quantitative parameters derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) based on compressed sensing volumetric interpolated breath-hold (CS-VIBE) examination in the differential diagnosis of thyroid nodules. MATERIALS AND METHODS A total of 208 patients with 259 thyroid nodules scheduled for surgery operation were prospectively recruited. All participants underwent routine and DCE-MRI. DCE-MRI quantitative parameters [Ktrans, Kep, Ve], semi-quantitative parameters [wash-in, wash-out, time to peak (TTP), arrival time (AT), peak enhancement intensity (PEI), and initial area under curve in 60 s (iAUC)] and time-intensity curve (TIC) types were analyzed. Differential diagnostic performances were assessed using area under the receiver operating characteristic curve (AUC) and compared with the Delong test. RESULTS Ktrans, Kep, Ve, wash-in, wash-out, PEI and iAUC were statistically significantly different between malignant and benign nodules (P < 0.001). Among these parameters, ROC analysis revealed that Ktrans showed the highest diagnostic performance in the differentiation of benign and malignant nodules, followed by wash-in. ROC analysis also revealed that Ktrans achieved the best diagnostic performance for distinguishing papillary thyroid carcinoma (PTC) from non-PTC, follicular adenoma (FA) from non-FA, nodular goiter (NG) from non-NG, with AUC values of 0.854, 0.895 and 0.609, respectively. Type III curve is frequently observed in benign thyroid nodules, accounting for 77.4% (82/106). While malignant nodules are more common in type II, accounting for 57.5% (88/153). CONCLUSION Thyroid examination using CS-VIBE based DCE-MRI is a feasible, non-invasive method to identify benign and malignant thyroid nodules and pathological types.
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Affiliation(s)
- Junhao Huang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Daihong Liu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Jiao Chen
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Xiaoxia Wang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Lin Tang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Jing Zhang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Yong Tan
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Xiaosong Lan
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Ting Yin
- MR Collaborations, Siemens Healthineers Ltd., Chengdu, China
| | - Dominik Nickel
- MR Applications Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Jian Wu
- Head and Neck Cancer Center, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China.
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Martín-Noguerol T, Santos-Armentia E, Fernandez-Palomino J, López-Úbeda P, Paulano-Godino F, Luna A. Role of advanced MRI sequences for thyroid lesions assessment. A narrative review. Eur J Radiol 2024; 176:111499. [PMID: 38735157 DOI: 10.1016/j.ejrad.2024.111499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/12/2024] [Accepted: 05/05/2024] [Indexed: 05/14/2024]
Abstract
Despite not being the first imaging modality for thyroid gland assessment, Magnetic Resonance Imaging (MRI), thanks to its optimal tissue contrast and spatial resolution, has provided some advancements in detecting and characterizing thyroid abnormalities. Recent research has been focused on improving MRI sequences and employing advanced techniques for a more comprehensive understanding of thyroid pathology. Although not yet standard practice, advanced MRI sequences have shown high accuracy in preliminary studies, correlating well with histopathological results. They particularly show promise in determining malignancy risk in thyroid lesions, which may reduce the need for invasive procedures like biopsies. In this line, functional MRI sequences like Diffusion Weighted Imaging (DWI), Dynamic Contrast-Enhanced MRI (DCE-MRI), and Arterial Spin Labeling (ASL) have demonstrated their potential usefulness in evaluating both diffuse thyroid conditions and focal lesions. Multicompartmental DWI models, such as Intravoxel Incoherent Motion (IVIM) and Diffusion Kurtosis Imaging (DKI), and novel methods like Amide Proton Transfer (APT) imaging or artificial intelligence (AI)-based analyses are being explored for their potential valuable insights into thyroid diseases. This manuscript reviews the critical physical principles and technical requirements for optimal functional MRI sequences of the thyroid and assesses the clinical utility of each technique. It also considers future prospects in the context of advanced MR thyroid imaging and analyzes the current role of advanced MRI sequences in routine practice.
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Affiliation(s)
| | | | | | | | | | - Antonio Luna
- MRI unit, Radiology department. HT medica, Carmelo Torres 2, 23007 Jaén, Spain.
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Zheng T, Wang L, Wang H, Tang L, Xie X, Fu Q, Wu PY, Song B. Prediction model based on MRI morphological features for distinguishing benign and malignant thyroid nodules. BMC Cancer 2024; 24:256. [PMID: 38395783 PMCID: PMC10885392 DOI: 10.1186/s12885-024-11995-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The low specificity of Thyroid Imaging Reporting and Data System (TI-RADS) for preoperative benign-malignant diagnosis leads to a large number of unnecessary biopsies. This study developed and validated a predictive model based on MRI morphological features to improve the specificity. METHODS A retrospective analysis was conducted on 825 thyroid nodules pathologically confirmed postoperatively. Univariate and multivariate logistic regression were used to obtain β coefficients, construct predictive models and nomogram incorporating MRI morphological features in the training cohort, and validated in the validation cohort. The discrimination, calibration, and decision curve analysis of the nomogram were performed. The diagnosis efficacy, area under the curve (AUC) and net reclassification index (NRI) were calculated and compared with TI-RADS. RESULTS 572 thyroid nodules were included (training cohort: n = 397, validation cohort: n = 175). Age, low signal intensity on T2WI, restricted diffusion, reversed halo sign in delay phase, cystic degeneration and wash-out pattern were independent predictors of malignancy. The nomogram demonstrated good discrimination and calibration both in the training cohort (AUC = 0.972) and the validation cohort (AUC = 0.968). The accuracy, sensitivity, specificity, PPV, NPV and AUC of MRI-based prediction were 94.4%, 96.0%, 93.4%, 89.9%, 96.5% and 0.947, respectively. The MRI-based prediction model exhibited enhanced accuracy (NRI>0) in comparison to TI-RADSs. CONCLUSIONS The prediction model for diagnosis of benign and malignant thyroid nodules demonstrated a more notable diagnostic efficacy than TI-RADS. Compared with the TI-RADSs, predictive model had better specificity along with a high sensitivity and can reduce overdiagnosis and unnecessary biopsies.
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Affiliation(s)
- Tingting Zheng
- Department of Radiology, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Lanyun Wang
- Department of Radiology, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Hao Wang
- Department of Radiology, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Lang Tang
- Department of Ultrasound, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Xiaoli Xie
- Department of Pathology, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Qingyin Fu
- Department of Ultrasound, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Pu-Yeh Wu
- GE Healthcare, MR Research China, Beijing, China
| | - Bin Song
- Department of Radiology, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China.
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Li J, Wang Y, Ma JX, Dong BC, Sun L, Zhou W. Flushing effect of micro-bolus pulse injection and its potential impact on peripheral veins under hemostasis. Medicine (Baltimore) 2023; 102:e35607. [PMID: 37933034 PMCID: PMC10627611 DOI: 10.1097/md.0000000000035607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/21/2023] [Indexed: 11/08/2023] Open
Abstract
To explore the feasibility of using micro-bolus pulse injection method to reduce the dilution effect of pipeline on high concentration injection, and to understand low liquid volume bolus injection based on low injection speed. Using a programmable pulse injection pump, a 25-cm - long pipeline containing water-soluble fluorescent agent was flushed using different volumes of bolus, and the time spent for the complete disappearance of the fluorescent agent was recorded to evaluate the flushing efficiency. The finite element simulation of 2-phase flow was carried out using computational fluid dynamics (CFD) technology, and the difference of shear rate and pressure distribution in the vein of pulse injection and direct injection of bolus under hemostasis was compared and simulated. Micro-bolus pulse flushing has advantages in completing perfusion imaging applications, such as small volume imaging agent injection. Compared with non-pulse injection, the effective flushing volume decreases by 49.7%, the average injection speed decreases by 56%, and the maintenance time of high shear rate is shorter when using micro-bolus pulse injection. The impact of micro-bolus pulse injection on the vein can achieve the same or even lower negative effects as other injection methods after increasing the hemostatic distance to 100 mm. In the case of bolus injection requiring high concentration and small volume, such as for radiopharmaceutical dynamic imaging, the application of micro-bolus pulse injection is an effective way to overcome the dilution phenomenon of the imaging agent in the pipeline. During hemostasis, the micro-bolus pulse injection needs to control a longer hemostasis distance to reduce the potential impact on peripheral veins.
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Affiliation(s)
- Jin Li
- Tianjin Hospital, Tianjin University, Tianjin, People’s Republic of China
- CNNC High Energy Equipment (Tianjin) Co., Ltd., Tianjin, People’s Republic of China
| | - Yan Wang
- Tianjin Hospital, Tianjin University, Tianjin, People’s Republic of China
| | - Jian-xiong Ma
- Tianjin Hospital, Tianjin University, Tianjin, People’s Republic of China
| | - Ben-chao Dong
- Tianjin Hospital, Tianjin University, Tianjin, People’s Republic of China
| | - Lei Sun
- Tianjin Hospital, Tianjin University, Tianjin, People’s Republic of China
| | - Wei Zhou
- CNNC High Energy Equipment (Tianjin) Co., Ltd., Tianjin, People’s Republic of China
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李 晋, 王 岩, 马 剑, 庞 新, 周 围, 田 存, 杨 国, 赵 娜. [Application of micro-bolus injection and piezoelectric sensors to improve the safety of radiopharmaceuticals bolus injection]. SHENG WU YI XUE GONG CHENG XUE ZA ZHI = JOURNAL OF BIOMEDICAL ENGINEERING = SHENGWU YIXUE GONGCHENGXUE ZAZHI 2023; 40:982-988. [PMID: 37879928 PMCID: PMC10600418 DOI: 10.7507/1001-5515.202305017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/28/2023] [Indexed: 10/27/2023]
Abstract
Radiopharmaceutical dynamic imaging typically necessitates intravenous injection via the bolus method. However, manual bolus injection carries the risk of handling errors as well as radiological injuries. Hence, there is potential for automated injection devices to replace manual injection methods. In this study, the effect of micro-bolus pulse injection technology was compared and verified by radioactive experiments using a programmable injection pump, and the overall bubble recognition experiment and rat tail vein simulation injection verification were performed using the piezoelectric sensor preloading method. The results showed that at the same injection peak speed, the effective flushing volume of micro-bolus pulse flushing (about 83 μL/pulse) was 49.65% lower than that of uniform injection and 25.77% lower than that of manual flushing. In order to avoid the dilution effect of long pipe on the volume of liquid, the use of piezoelectric sensor for sealing preloading detection could accurately predict the bubbles of more than 100 μL in the syringe. In the simulated injection experiment of rat tail vein, when the needle was placed in different tissues by preloading 100 μL normal saline, the piezoelectric sensor fed back a large difference in pressure attenuation rate within one second, which was 2.78% in muscle, 17.28% in subcutaneous and 54.71% in vein. Micro-bolus pulse injection method and piezoelectric sensor sealing preloading method have application potential in improving the safety of radiopharmaceutical automatic bolus injection.
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Affiliation(s)
- 晋 李
- 天津大学天津医院(天津 300211)Tianjin Hospital, Tianjin University, Tianjin 300211, P. R. China
- 中核高能(天津)装备有限公司(天津 300300)CNNC High Energy Equipment (Tianjin) Co., Ltd., Tianjin 300300, P. R. China
| | - 岩 王
- 天津大学天津医院(天津 300211)Tianjin Hospital, Tianjin University, Tianjin 300211, P. R. China
| | - 剑雄 马
- 天津大学天津医院(天津 300211)Tianjin Hospital, Tianjin University, Tianjin 300211, P. R. China
| | - 新新 庞
- 天津大学天津医院(天津 300211)Tianjin Hospital, Tianjin University, Tianjin 300211, P. R. China
| | - 围 周
- 天津大学天津医院(天津 300211)Tianjin Hospital, Tianjin University, Tianjin 300211, P. R. China
| | - 存贵 田
- 天津大学天津医院(天津 300211)Tianjin Hospital, Tianjin University, Tianjin 300211, P. R. China
| | - 国辉 杨
- 天津大学天津医院(天津 300211)Tianjin Hospital, Tianjin University, Tianjin 300211, P. R. China
| | - 娜 赵
- 天津大学天津医院(天津 300211)Tianjin Hospital, Tianjin University, Tianjin 300211, P. R. China
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Calle S, Choi J, Ahmed S, Bell D, Learned KO. Imaging of the Thyroid: Practical Approach. Neuroimaging Clin N Am 2021; 31:265-284. [PMID: 34243863 DOI: 10.1016/j.nic.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Imaging evaluation of the thyroid gland spans a plethora of modalities, including ultrasound imaging, cross-sectional studies, and nuclear medicine techniques. The overlapping of clinical and imaging findings of benign and malignant thyroid disease can make interpretation a complex undertaking. We aim to review and simplify the vast current literature and provide a practical approach to the imaging of thyroid disease for application in daily practice. Our approach highlights the keys to differentiating and diagnosing common benign and malignant disease affecting the thyroid gland.
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Affiliation(s)
- Susana Calle
- Department of Neuroradiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street Unit 1482, Houston, TX 77030, USA.
| | - Jeanie Choi
- Neuroradiology Section, Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USA
| | - Salmaan Ahmed
- Department of Neuroradiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street Unit 1482, Houston, TX 77030, USA
| | - Diana Bell
- Head and Neck Section, Departments of Pathology and Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Kim O Learned
- Department of Neuroradiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street Unit 1482, Houston, TX 77030, USA
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Malla SR, Bhalla AS, Manchanda S, Kandasamy D, Kumar R, Agarwal S, Shamim SA, Kakkar A. Dynamic contrast-enhanced magnetic resonance imaging for differentiating head and neck paraganglioma and schwannoma. Head Neck 2021; 43:2611-2622. [PMID: 33938085 DOI: 10.1002/hed.26732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 03/27/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Morphological assessment with conventional magnetic resonance imaging (MRI) sequences has limited specificity to distinguish between paragangliomas and schwannomas. Assessing the differences in microvascular properties through pharmacokinetic parameters of dynamic contrast-enhanced (DCE)-MRI can provide additional information to aid in this differentiation. MATERIALS AND METHODS A prospective study on MR characterization of neck masses was performed between January 2017 and March 2019 in our department, out of which 40 patients with head and neck paragangliomas (HNPGLs) (33 lesions) and schwannomas (15 lesions) were included in this analysis. MR perfusion using dynamic axial T1WI fat suppressed fast spoiled gradient recalled sequence with parallel imaging was performed in all the patients, in addition to single-shot turbo spin-echo axial diffusion weighted imaging (DWI) and routine MRI. ROI-based method was used to obtain signal-time curves, permeability measurements, and mean apparent diffusion coefficient (ADC) to differentiate paragangliomas from schwannomas. Statistical analysis was done to assess the significance and establish a cutoff to distinguish between the two entities. The available images of DOTANOC PET/CT (34 lesions) were analyzed retrospectively. Correlations between the perfusion, diffusion, and molecular PET/CT parameters were done. RESULTS Paragangliomas had a higher wash-in rate, wash-out rate, Ktrans, Kep , and Vp (p < 0.001); while schwannomas had a higher relative enhancement (p < 0.012), time to peak, time of onset, brevity of enhancement, and Ve (p < 0.001). Among the perfusion parameters, Kep (area under curve (AUC) 0.994) and Vp (AUC 0.992) were found to have the highest diagnostic value. In diffusion-weighted imaging, paragangliomas had a lower mean ADC compared to schwannomas (p < 0.001). The SUVmax and SUVmean were significantly associated with Ktrans , Kep , and Vp in paragangliomas. CONCLUSION DCE-MRI in addition to DWI-MRI can accurately distinguish HNPGL from schwannoma and may replace the need for any additional imaging and preoperative biopsy in most cases.
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Affiliation(s)
- Soumya Ranjan Malla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rakesh Kumar
- Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Shamim Ahmed Shamim
- Department of Nuclear Medicine & PET, All India Institute of Medical Sciences, New Delhi, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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