Nonisotopic Thyroid Imaging
Thyroid ultrasonography (US) is a reliable diagnostic tool for the evaluation of focal and diffuse thyroid disease. US accurately identifies the size and location of thyroid nodules and defines their risk of malignancy. Irregular margins, microcalcifications, taller-than-wide shape, deep hypoechogenicity and extrathyroid extension are clear-cut signs of malignancy while the predictive role of color-doppler and elastography findings is still controversial. The use of the recently proposed US classifications systems decreases the possible inconsistency of US descriptive reports, provides a reproducible tool to select lesions that should undergo aspiration biopsy, and improves the communication between sonographers, clinicians and pathologists. Additionally, US examination may suggest an altered thyroid function or an inflammatory condition or confirm size abnormalities and changes of thyroid structure.
The expensive cross-sectional imaging techniques (computed tomography or magnetic resonance imaging) are less sensitive and specific tools for the diagnosis of thyroid diseases. These imaging modalities should be used in the presurgical staging of thyroid malignancies at risk of extra-thyroidal spread to demonstrate the involvement of cervical structures and planning the extension of surgery. Their use in the postsurgical surveillance of cervical cancer recurrences appears limited and is indicated mainly in patients with increasing thyroglobulin (or calcitonin) levels and inconclusive neck US.
The role of functional imaging methods (thyroid scintiscan and PET/CT) is addressed in the dedicated section of this text.
KeywordsThyroid imaging Thyroid ultrasound Computerized tomography Magnetic resonance imaging Thyroid nodules
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