Generic placeholder image

Current Medical Imaging

Author(s): Meltem Özdemir* and Rasime Pelin Kavak

DOI: 10.2174/1573405615666190220105229

DownloadDownload PDF Flyer Cite As
Incidentally Discovered Thyroid Nodules by Routine Magnetic Resonance Imaging of the Cervical Spine: Incidence and Clinical Significance

Page: [677 - 681] Pages: 5

  • * (Excluding Mailing and Handling)

Abstract

Objective: The aim of our study was to present the prevalence of thyroid nodules we incidentally discovered by routine Magnetic Resonance Imaging (MRI) of the cervical spine, to evaluate their clinical significance, and to discuss the current clinical approach to incidental thyroid nodules.

Methods: We retrospectively evaluated the cervical spinal MRI studies of 512 patients. Thyroid glands were evaluated for morphologic and signal characteristics and examined for the presence of nodule(s). The nodules with a maximum diameter of 5 mm or more were taken into analysis.

Results: Of 512 MRI studies, 254 revealed incidental thyroid nodule(s) (49.6%). The mean maximum nodule diameter was 7.48±2.92 mm. Thirty-eight of 254 incidental thyroid nodules were radiologically reported, 35 reported nodules were evaluated by US, and 22 were further analyzed by fine needle aspiration cytology. The final diagnosis of 11 aspirated nodules was an adenomatous nodule, whereas 3 were papillary thyroid carcinoma. One of the patients with papillary thyroid carcinoma was a 32-year-old man with a nodule with a maximum diameter of 7 mm.

Conclusion: Incidental thyroid nodule is a frequent non-spinal lesion detected by routine cervical spinal MRI. The 3-tiered system which is recommended in the clinical approach to incidental thyroid nodules may miss some clinically significant thyroid nodules. We suggest the criteria of this system to be re-evaluated and modified if necessary. In addition, we would like to emphasize the need for a guideline for radiologists for reporting incidental thyroid nodules on MRI on the basis of a standard clinical approach.

Keywords: Incidental thyroid nodule, magnetic resonance imaging, cervical spine, thyroid cancer, papillary thyroid carcinoma, computed tomography.

Graphical Abstract

[1]
Kamath S, Jain N, Goyal N, Mansour R, Mukherjee K. Incidental findings on MRI of the spine. Clin Radiol 2009; 64(4): 353-61.
[http://dx.doi.org/10.1016/j.crad.2008.09.010] [PMID: 19264178]
[2]
Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19(11): 1167-214.
[http://dx.doi.org/10.1089/thy.2009.0110] [PMID: 19860577]
[3]
Choi N, Moon WJ, Kim HY, Roh HG, Choi JW. Thyroid incidentaloma detected by time-resolved magnetic resonance angiography at 3T: prevalence and clinical significance. Korean J Radiol 2012; 13(3): 275-82.
[http://dx.doi.org/10.3348/kjr.2012.13.3.275] [PMID: 22563264]
[4]
Kim K, Emoto N, Mishina M, et al. Incidental detection of thyroid nodules at magnetic resonance imaging of the cervical spine. Neurol Med Chir (Tokyo) 2013; 53(2): 77-81.
[http://dx.doi.org/10.2176/nmc.53.77] [PMID: 23438656]
[5]
McKenna DA, Laxpati M, Colletti PM. The prevalence of incidental findings at cardiac MRI. Open Cardiovasc Med J 2008; 2: 20-5.
[http://dx.doi.org/10.2174/1874192400802010020] [PMID: 18949093]
[6]
Davies L, Pichiotino E, Black WC, Tosteson ANA. Developing a registry for thyroid incidentalomas: lessons learned and the path forward. Thyroid 2016; 26(5): 650-6.
[http://dx.doi.org/10.1089/thy.2015.0390] [PMID: 27028799]
[7]
Bartolotta TV, Midiri M, Runza G, et al. Incidentally discovered thyroid nodules: incidence, and greyscale and colour Doppler pattern in an adult population screened by real-time compound spatial sonography. Radiol Med (Torino) 2006; 111(7): 989-98.
[http://dx.doi.org/10.1007/s11547-006-0097-1] [PMID: 17021683]
[8]
Brander A, Viikinkoski P, Nickels J, Kivisaari L. Thyroid gland: US screening in a random adult population. Radiology 1991; 181(3): 683-7.
[http://dx.doi.org/10.1148/radiology.181.3.1947082] [PMID: 1947082]
[9]
Ezzat S, Sarti DA, Cain DR, Braunstein GD. Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Intern Med 1994; 154(16): 1838-40.
[http://dx.doi.org/10.1001/archinte.1994.00420160075010] [PMID: 8053752]
[10]
Steele SR, Martin MJ, Mullenix PS, Azarow KS, Andersen CA. The significance of incidental thyroid abnormalities identified during carotid duplex ultrasonography. Arch Surg 2005; 140(10): 981-5.
[http://dx.doi.org/10.1001/archsurg.140.10.981] [PMID: 16230549]
[11]
Yoon DY, Chang SK, Choi CS, et al. The prevalence and significance of incidental thyroid nodules identified on computed tomography. J Comput Assist Tomogr 2008; 32(5): 810-5.
[http://dx.doi.org/10.1097/RCT.0b013e318157fd38] [PMID: 18830117]
[12]
Kawano Y, Tamura A, Goto Y, Shinozaki K, Zaizen H, Kadota J. Incidental detection of cancers and other non-cardiac abnormalities on coronary multislice computed tomography. Am J Cardiol 2007; 99(11): 1608-9.
[http://dx.doi.org/10.1016/j.amjcard.2007.01.038] [PMID: 17531590]
[13]
Youserm DM, Huang T, Loevner LA, Langlotz CP. Clinical and economic impact of incidental thyroid lesions found with CT and MR. AJNR Am J Neuroradiol 1997; 18(8): 1423-8.
[PMID: 9296181]
[14]
Hoang JK, Nguyen XV. Understanding the Risks and Harms of Management of Incidental Thyroid Nodules: A Review. JAMA Otolaryngol Head Neck Surg 2017; 143(7): 718-24.
[http://dx.doi.org/10.1001/jamaoto.2017.0003] [PMID: 28426843]
[15]
Hoang JK, Grady AT, Nguyen XV. What to do with incidental thyroid nodules identified on imaging studies? Review of current evidence and recommendations. Curr Opin Oncol 2015; 27(1): 8-14.
[http://dx.doi.org/10.1097/CCO.0000000000000147] [PMID: 25310642]
[16]
Bahl M, Sosa JA, Eastwood JD, Hobbs HA, Nelson RC, Hoang JK. Using the 3-tiered system for categorizing workup of incidental thyroid nodules detected on CT, MRI, or PET/CT: how many cancers would be missed? Thyroid 2014; 24(12): 1772-8.
[http://dx.doi.org/10.1089/thy.2014.0066] [PMID: 25203387]
[17]
Hoang JK, Langer JE, Middleton WD, et al. Managing incidental thyroid nodules detected on imaging: white paper of the ACR Incidental Thyroid Findings Committee. J Am Coll Radiol 2015; 12(2): 143-50.
[http://dx.doi.org/10.1016/j.jacr.2014.09.038] [PMID: 25456025]
[18]
Farrá JC, Picado O, Liu S, et al. Clinically significant cancer rates in incidentally discovered thyroid nodules by routine imaging. J Surg Res 2017; 219: 341-6.
[http://dx.doi.org/10.1016/j.jss.2017.06.050] [PMID: 29078903]
[19]
Hoang JK, Riofrio A, Bashir MR, Kranz PG, Eastwood JD. High variability in radiologists’ reporting practices for incidental thyroid nodules detected on CT and MRI. AJNR Am J Neuroradiol 2014; 35(6): 1190-4.
[http://dx.doi.org/10.3174/ajnr.A3834] [PMID: 24407274]
[20]
Grady AT, Sosa JA, Tanpitukpongse TP, Choudhury KR, Gupta RT, Hoang JK. Radiology reports for incidental thyroid nodules on CT and MRI: high variability across subspecialties. AJNR Am J Neuroradiol 2015; 36(2): 397-402.
[http://dx.doi.org/10.3174/ajnr.A4089] [PMID: 25147197]
[21]
Tanpitukpongse TP, Grady AT, Sosa JA, Eastwood JD, Choudhury KR, Hoang JK. Incidental Thyroid nodules on CT or MRI: discordance between what we report and what receives workup. AJR Am J Roentgenol 2015; 205(6): 1281-7.
[http://dx.doi.org/10.2214/AJR.15.14929] [PMID: 26587935]
[22]
Mancuso AA. Oh #*$%#! Another pesky incidental thyroid nodule! AJNR Am J Neuroradiol 2005; 26(10): 2444-5.
[PMID: 16286383]
[23]
University of Health Sciences Dışkapı Training and Research Hospital Available from:. https://diskapieah.saglik.gov.tr