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Computed tomography complements ultrasound for the differential diagnosis of traumatic neuroma from recurrent tumor in patients with postoperative thyroid cancer

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Abstract

Objectives

Traumatic neuromas (TNs) mimic recurrent tumors in US after total thyroidectomy (TT) and lateral neck dissection (LND) for thyroid cancer. We aimed to evaluate whether CT could complement US in the differential diagnosis of TNs from recurrent thyroid cancer in the dissected neck.

Material and methods

We retrospectively included a total of 97 consecutive US-detected lesions (28 TNs and 69 recurrent tumors) in patients with a previous history of TT and LND for thyroid cancer. The lesions were classified as benign, indeterminate, or suspicious according to the presence of benign or suspicious features on US and CT. Imaging features and categories on US and CT were compared between TNs and recurrent tumors. The diagnostic performances of US and CT for differentiating between TNs and recurrent tumors were calculated.

Results

On US, most TNs and recurrent tumors showed internal hyperechogenicity without hilar echogenicity or hilar vascularity and were categorized as suspicious lesions (23/28, 82.1% vs. 53/69, 76.8%). On CT, all TNs lacked strong enhancement without hilar fat or hilar vessel enhancement and were categorized as indeterminate lesions (28/28, 100%). In contrast, most recurrent tumors showed strong enhancement and were categorized as suspicious lesions (63/69, 91.3%). The addition of CT to US corrected 23 false-positive diagnoses in 28 TNs and 10 false-negative diagnoses in 69 recurrent tumors.

Conclusions

CT complements US for the correct differentiation of TNs from recurrent tumors in postoperative thyroid cancer patients. The addition of CT to US may prevent unnecessary painful biopsy or surgery.

Key Points

• In the dissected neck, traumatic neuromas could mimic US suspicious LNs owing to its internal hyperechogenicity.

• CT effectively differentiated traumatic neuromas from recurrent thyroid cancers by demonstrating significantly different enhancement patterns.

• CT could complement US and may prevent unnecessary painful biopsy or surgery for US-detected lesions after thyroidectomy and neck dissection.

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Abbreviations

CCA:

Common carotid artery

CT:

Computed tomography

FNA:

Fine needle aspiration

ICC:

Intra-class coefficient

LND:

Lateral neck dissection

ROI:

Region of interest

SD:

Short diameter

TN:

Traumatic neuroma

TT:

Total thyroidectomy

US:

Ultrasound

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongnogu, Seoul, 03080, Korea

    Ji Ye Lee, Ji-hoon Kim, Eung Koo Yeon, Inpyeong Hwang, Roh-Eul Yoo, Koung Mi Kang, Tae Jin Yun, Seung Hong Choi & Chul-Ho Sohn

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  1. Ji Ye Lee
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Correspondence to Ji-hoon Kim.

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Lee, J.Y., Kim, Jh., Yeon, E.K. et al. Computed tomography complements ultrasound for the differential diagnosis of traumatic neuroma from recurrent tumor in patients with postoperative thyroid cancer. Eur Radiol 32, 2760–2768 (2022). https://doi.org/10.1007/s00330-021-08321-x

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