A comparison of radionuclide thyroid angiography, 99mTc-MIBI scintigraphy and power Doppler ultrasonography in the differential diagnosis of solitary cold thyroid nodules

  • Koray Demirel
  • Özlem Kapucu
  • Cem Yücel
  • Hakan Özdemir
  • Göksun Ayvaz
  • Ferit Taneri
Original Article

DOI: 10.1007/s00259-003-1124-2

Cite this article as:
Demirel, K., Kapucu, Ö., Yücel, C. et al. Eur J Nucl Med Mol Imaging (2003) 30: 642. doi:10.1007/s00259-003-1124-2

Abstract

We prospectively studied 43 patients with solitary cold thyroid nodules greater than 1.5 cm in diameter to determine the comparative diagnostic value of radionuclide thyroid angiography (RTA), technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy and power Doppler ultrasonography (PDUS) in the differentiation of benign and malignant thyroid nodules. Perfusion of the nodules in RTA was compared with the perfusion in the surrounding normal thyroid tissue and classified as follows: 0, avascular; 1, hypovascular; 2, isovascular; 3, hypervascular. 99mTc-MIBI uptake in the nodules compared with that in surrounding thyroid tissue was scored for both early and delayed images as follows: 0, cold; 1, decreased; 2, equal; 3, increased. PDUS patterns were classified as nodule vascularisation patterns. The malignancy criteria were set as follows: hypervascular nodule with rapid washout in RTA; complex ring sign with anarchic structure or delta sign in PDUS, and positive retention and increased uptake in the nodule in the early and delayed 99mTc-MIBI images. These data were compared with the histopathological results. Histology revealed thyroid carcinoma in nine patients (five cases of papillary carcinoma, three of follicular carcinoma and one of medullary carcinoma) and benign conditions in 34 patients (30 cases of nodular goitre, three of lymphocytic thyroiditis and one of follicular adenoma). Sensitivity, specificity and accuracy were, respectively, 0.89, 1.00 and 0.97 for RTA, 1.00, 0.76 and 0.81 for PDUS, and 0.67, 0.91 and 0.86 for 99mTc-MIBI scintigraphy (when nodules with increased uptake in both the early and the delayed images and a positive retention index were considered as malignant). RTA, 99mTc-MIBI scintigraphy and PDUS could be helpful in the preoperative assessment of solitary cold thyroid nodules. In this study, RTA was found to be the most accurate and specific method for differentiation of malignant from benign thyroid nodules.

Keywords

Radionuclide angiography 99mTc-MIBI Power Doppler ultrasonography Thyroid nodules Histopathology 

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Koray Demirel
    • 1
    • 2
  • Özlem Kapucu
    • 1
  • Cem Yücel
    • 3
  • Hakan Özdemir
    • 3
  • Göksun Ayvaz
    • 4
  • Ferit Taneri
    • 5
  1. 1.Department of Nuclear MedicineGazi University School of MedicineAnkaraTurkey
  2. 2.Dikmen caddesiNo=205/28 DikmenAnkaraTurkey
  3. 3.Department of RadiologyGazi University School of MedicineAnkaraTurkey
  4. 4.Department of Endocrinology and Metabolic DiseasesGazi University School of MedicineAnkaraTurkey
  5. 5.Department of SurgeryGazi University School of MedicineAnkaraTurkey

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