Imaging
Thyroid Nodule
- Preliminary Diagnosis: Thyroid Nodule
-
I. What imaging technique is first-line for this diagnosis?
- II. Describe the advantages and disadvantages of this technique for diagnosing a thyroid nodule.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosing a thyroid nodule.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Thyroid Nodule
I. What imaging technique is first-line for this diagnosis?
Ultrasound of the thyroid gland.
II. Describe the advantages and disadvantages of this technique for diagnosing a thyroid nodule.
Advantages
Does not expose patients to ionizing radiation.
Highly portable and relatively inexpensive imaging modality.
Helps detail the vascularity and complexity of any suspected thyroid nodular abnormalities.
May guide percutaneous biopsy and fine needle aspiration.
Disadvantages
Highly operator dependent.
III. What are the contraindications for the first-line imaging technique?
No specific contraindications to ultrasound exist.
IV. What alternative imaging techniques are available?
CT of the thyroid bed with IV contrast.
MR of the thyroid bed with IV contrast.
Nuclear medicine thyroid scintigraphy utilizing Technetium 99 m pertechtenate and I-123.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing a thyroid nodule.
CT of the thyroid bed with IV contrast
Advantages
Offers better evaluation of the surrounding soft tissues and osseous structures than ultrasound.
Evaluates for extension of local thyroid disease/neoplasm and distant metastasis.
Disadvantages
Less sensitive and specific in characterizing the complexity and vascularity of thyroid nodular lesions than ultrasound.
Less portable and relatively more expensive compared to sonographic imaging.
Exposes patients to ionizing radiation.
MR of the thyroid bed with IV contrast
Advantages
Does not expose patients to ionizing radiation.
Offers exquisite evaluation of the surrounding soft tissues.
Highly adept in detailing any evidence of distant cervical lymphadenopathy and metastasis.
Disadvantages
Expensive.
Time consuming.
Less adept in detailing subtle thyroid mineralization which is characteristic in certain thyroid abnormalities, i.e., medullary carcinoma.
Less adept in guiding percutaneous biopsy and therapy.
May be subject to motion and susceptibility weighted artifact, degrading image quality.
Nuclear medicine thyroid scintigraphy utilizing Technetium 99 m pertechtenate and I-123
Advantages
Moderate in sensitivity and moderate in detailing hot or cold thyroid nodules.
Disadvantages
Limited in detailing the surrounding soft tissues, vasculature, and osseous structures.
Exposes patients to ionizing radiation.
Limited in sensitivity and specificity in detecting and detailing small thyroid nodules.
Unable to adequately detail the vascularity of a thyroid lesion.
VI. What are the contraindications for the alternative imaging techniques?
CT of the thyroid bed with IV contrast
May be contraindicated in pregnant patients.
IV contrast may be contraindicated in patients with renal failure or contrast allergy.
MR of the thyroid bed with IV contrast
Contraindicated in patients with non-MR compatible hardware.
Nuclear medicine thyroid scintigraphy utilizing Technetium 99 m pertechtenate and I-123
May be contraindicated in pregnant and breast feeding patients.
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