Clinical and Translational Oncology

, Volume 21, Issue 11, pp 1561–1567 | Cite as

Role of multi-modality functional imaging in differentiation between benign and malignant thyroid 18F-fluorodeoxyglucose incidentaloma

  • H. Shi
  • Z. YuanEmail author
  • C. Yang
  • J. Zhang
  • C. Liu
  • J. Sun
  • X. YeEmail author
Research Article



To evaluate the diagnostic performance of multi-modality functional imaging in differentiating malignant and benign thyroid 18F-fluorodeoxyglucose (18F-FDG) incidentaloma.


This study included 87 patients with thyroid 18F-FDG incidentalomas detected by 18F-FDG- positron emission tomography/computed tomography (18F-FDG-PET/CT) and diagnosed at surgery or biopsy, who received 18F-FDG-PET/CT, diffusion-weighted MR imaging (DWI) and ultrasound elastography (USE). The metabolic tumor volume (MTV), total lesion glycolysis (TLG), apparent diffusion coefficient (ADC) values and ultrasound elasticity scores of thyroid 18F-FDG incidentalomas were measured and compared in benign and malignant thyroid incidentalomas. The differences of malignant and benign thyroid incidentalomas were tested by χ2 test, Fisher’s exact test, t test, or Mann–Whitney U test. The diagnostic performance was evaluated and optimal cut-off values were determined in distinguishing malignant from benign thyroid incidentalomas by receiver operating characteristic curve analysis.


MTV, TLG and USE scores of malignant thyroid incidentalomas were significantly higher than benign; but ADC value was significantly lower. We defined the functional imaging parameters TLG < 2.48, ADC > 1.80 × 10−3mm2/s, and USE score of 1 as markers of benign thyroid incidentalomas and each scored -1 point; TLG ≥ 2.48, ADC ≤ 1.80 × 10−3mm2/s, and USE score of 4 as markers of malignancy and each scored 1 point. Combined multi-functional imaging parameters achieved the highest performance (84.6% sensitivity and 97.1% specificity) for distinguish malignant from benign thyroid incidentaloma with AUC 0.957 (95% CI 0.917, 0.997).


Functional imaging might help to distinguishing malignant from benign thyroid 18F-FDG incidentalomas, and combined multi-functional imaging parameters could improve it.


Neoplasms thyroid Positron emission tomography/computed tomography Diffusion-weighted imaging Ultrasound imaging Elasticity imaging techniques 



This study was partly supported by the National Natural Science Foundation of China (Grant number 81571629) and Shanghai Municipal of Health and Family Planning Commission (20164Y0014).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional ethics committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Burguera B, Gharib H. Thyroid incidentalomas. Prevalence, diagnosis, significance, and management. Endocrinol Metab Clin N Am. 2000;29:187–203.CrossRefGoogle Scholar
  2. 2.
    Bomanji JB, Costa DC, Ell PJ. Clinical role of positron emission tomography in oncology. Lancet Oncol. 2001;2:157–64.CrossRefGoogle Scholar
  3. 3.
    Chen YK, Ding HJ, Chen KT, Chen YL, Liao AC, Shen YY, et al. Prevalence and risk of cancer of focal thyroid incidentaloma identified by 18F-fluorodeoxyglucose positron emission tomography for cancer screening in healthy subjects. Anticancer Res. 2005;25:1421–6.PubMedGoogle Scholar
  4. 4.
    Bakshi NA, Mansoor I, Jones BA. Analysis of inconclusive fine-needle aspiration of thyroid follicular lesions. Endocr Pathol. 2003;14:167–75.CrossRefGoogle Scholar
  5. 5.
    Tollin SR, Mery GM, Jelveh N, Fallon EF, Mikhail M, Blumenfeld W, et al. The use of fine-needle aspiration biopsy under ultrasound guidance to assess the risk of malignancy in patients with a multinodular goiter. Thyroid. 2000;10:235–41.CrossRefGoogle Scholar
  6. 6.
    Ríos A, Rodríguez JM, Galindo PJ, Montoya M, Tebar FJ, Sola J, et al. Utility of fine-needle aspiration for diagnosis of carcinoma associated with multinodular goitre. Clin Endocrinol (Oxf). 2004;61:732–7.CrossRefGoogle Scholar
  7. 7.
    Azizi G, Keller J, Lewis M, Puett D, Rivenbark K, Malchoff C. Performance of elastography for the evaluation of thyroid nodules: a prospective study. Thyroid. 2013;23:734–40.CrossRefGoogle Scholar
  8. 8.
    Van de Wiele C, Kruse V, Smeets P, Sathekge M, Maes A. Predictive and prognostic value of metabolic tumour volume and total lesion glycolysis in solid tumours. Eur J Nucl Med Mol Imaging. 2013;40:290–301.CrossRefGoogle Scholar
  9. 9.
    Erdem G, Erdem T, Muammer H, Mutlu DY, Firat AK, Sahin I, et al. Diffusion-weighted images differentiate benign from malignant thyroid nodules. J Magn Reson Imaging. 2010;31:94–100.CrossRefGoogle Scholar
  10. 10.
    Tezelman S, Giles Y, Tunca F, Gok K, Poyanli A, Salmaslioglu A, et al. Diagnostic value of dynamic contrast medium enhanced magnetic resonance imaging in preoperative detection of thyroid carcinoma. Arch Surg. 2007;142:1036–41.CrossRefGoogle Scholar
  11. 11.
    Shi H, Yuan Z, Yuan Z, Yang C, Zhang J, Shou Y, et al. Diagnostic value of volume-based fluorine-18-fluorodeoxyglucose PET/CT parameters for characterizing thyroid incidentaloma. Korean J Radiol. 2018;19:342–51.CrossRefGoogle Scholar
  12. 12.
    Bhatia KS, Rasalkar DP, Lee YP, Wong KT, King AD, Yuen HY, et al. Cystic change in thyroid nodules: a confounding factor for real-time qualitative thyroid ultrasound elastography. Clin Radiol. 2011;66:799–807.CrossRefGoogle Scholar
  13. 13.
    Rubaltelli L, Corradin S, Dorigo A, Stabilito M, Tregnaghi A, Borsato S, et al. Differential diagnosis of benign and malignant thyroid nodules at elastosonography. Ultraschall Med. 2009;30:175–9.CrossRefGoogle Scholar
  14. 14.
    Pagano L, Samà MT, Morani F, Prodam F, Rudoni M, Boldorini R, et al. Thyroid incidentaloma identified by 18F-fluorodeoxyglucose positron emission tomography with CT (FDG-PET/CT): clinical and pathological relevance. Clin Endocrinol (Oxf). 2011;75:528–34.CrossRefGoogle Scholar
  15. 15.
    Bertagna F, Treglia G, Piccardo A, Giubbini R. Diagnostic and clinical significance of F-18-FDGPET/CT thyroid incidentalomas. J Clin Endocrinol Metab. 2012;97:3866–75.CrossRefGoogle Scholar
  16. 16.
    Kim BH, Kim SJ, Kim H, Jeon YK, Kim SS, Kim IJ, et al. Diagnostic value of metabolic tumor volume assessed by 18F-FDG-PET/CT added to SUVmax for characterization of thyroid 18F-FDG incidentaloma. Nucl Med Commun. 2013;34:868–76.PubMedGoogle Scholar
  17. 17.
    Ho TY, Liou MJ, Lin KJ, Yen TC. Prevalence and significance of thyroid uptake detected by 18F FDG PET. Endocrine. 2011;40:297–302.CrossRefGoogle Scholar
  18. 18.
    Kim SJ, Chang S. Predictive value of intratumoral heterogeneity of F-18 FDG uptake for characterization of thyroid nodules according to Bethesda categories of fine needle aspiration biopsy results. Endocrine. 2015;50:681–8.CrossRefGoogle Scholar
  19. 19.
    Noda Y, Kanematsu M, Goshima S, Kondo H, Watanabe H, Kawada H, et al. MRI of the thyroid for differential diagnosis of benign thyroid nodules and papillary carcinomas. AJR Am J Roentgenol. 2015;204:W332–W33535.CrossRefGoogle Scholar
  20. 20.
    Sasaki M, Sumi M, Kaneko K, Ishimaru K, Takahashi H, Nakamura T. Multiparametric MR imaging for differentiating between benign and malignant thyroid nodules: initial experience in 23 patients. J Magn Reson Imaging. 2013;38:64–71.CrossRefGoogle Scholar
  21. 21.
    Hao Y, Pan C, Chen W, Li T, Zhu W, Qi J. Differentiation between malignant and benign thyroid nodules and stratification of papillary thyroid cancer with aggressive histological features: whole-lesion diffusion-weighted imaging histogram analysis. J Magn Reson Imaging. 2016;44:1546–55.CrossRefGoogle Scholar
  22. 22.
    Lyshchik A, Higashi T, Asato R, Tanaka S, Ito J, Mai JJ, et al. Thyroid gland tumor diagnosis at US elastography. Radiology. 2005;237:202–11.CrossRefGoogle Scholar
  23. 23.
    Sebag F, Vaillant-Lombard J, Berbis J, Griset V, Henry JF, Petit P, et al. Shear wave elastography: a new ultrasound imaging mode for the differential diagnosis of benign and malignant thyroid nodules. J Clin Endocrinol Metab. 2010;95:5281–8.CrossRefGoogle Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2019

Authors and Affiliations

  1. 1.Shanghai Universal Medical Imaging Diagnostic CenterShanghaiPeople’s Republic of China
  2. 2.Department of Radiology, PET/CT CenterShanghai 85 hospitalShanghaiPeople’s Republic of China
  3. 3.Department of Radiology, Shanghai Chest HospitalShanghai Jiaotong UniversityShanghaiPeople’s Republic of China

Personalised recommendations