Using Diffusion-Weighted MRI to Predict Central Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Feasibility Study

• Published in: Frontiers in endocrinology (Lausanne) Vol. 11; p. 326
• Main Authors: Zhang, Heng, Hu, Shudong, Wang, Xian, Liu, Wenhua, He, Junlin, Sun, Zongqiong, Ge, Yuxi, Dou, Weiqiang
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 12.06.2020
• Subjects: diffusion magnetic resonance imaging; Diffusion Magnetic Resonance Imaging - methods; Endocrinology; feasibility studies; Female; Follow-Up Studies; Humans; Lymphatic Metastasis; Male; Middle Aged; Neck Dissection - methods; nomograms; Prognosis; Retrospective Studies; Risk Factors; ROC Curve; thyroid cancer; Thyroid Cancer, Papillary - secondary; Thyroid Cancer, Papillary - surgery; Thyroid Neoplasms - pathology; Thyroid Neoplasms - surgery; Thyroidectomy - methods; diffusion magnetic resonance imaging; thyroid cancer; feasibility studies; nomograms; lymphatic metastasis
• ISSN: 1664-2392; 1664-2392
• DOI: 10.3389/fendo.2020.00326

To investigate whether diffusion-weighted imaging (DWI) with multi b values can be used as a quantitative assessment tool to predict central lymph node metastasis (CLNM) in papillary thyroid carcinoma (PTC). A total of 214 PTC patients were enrolled from January 2015 to April 2018. Each patient underwent multi b value DWI (300, 500, and 800 s/mm ) preoperatively and then clinical treatment of central LN dissection at the Thyroid Surgery Department. These patients were divided as two groups based on with and without CLNM. The corresponding apparent diffusion coefficients (ADCs) were evaluated with separated b value, i.e., 300, 500, or 800 s/mm . Clinicopathological variables and ADC values were analyzed retrospectively by using univariate and binary logistic regression. The corresponding obtained variables with statistical significance were further applied to create a nomogram in which the bootstrap resampling method was used for correction. PTCs with CLNM had significantly lower ADC , ADC , and ADC values compared with PTCs without CLNM. Using receiver operating characteristic (ROC) analysis, the ADC value (0.817) showed a higher area under the curve (AUC) than those of the ADC and ADC values (0.610 and 0.641, respectively) in differentiating patients with CLNM and without CLNM. The corresponding cutoff value for ADC was also determined (1.444 × 10 mm /s), with respective sensitivity and specificity of 88.6 and 66%. The nomogram was generated by binary logistic regression results, incorporating four variables: gender, primary tumor size, extrathyroidal extension (ETE), and ADC value. The AUC of the nomogram was 0.894 in predicting CLNM. Moreover, as shown in the calibration curve between nomogram and clinical findings, a strong agreement was observed in the prediction of CLNM. In summary, the ADC value is a valuable noninvasive imaging biomarker for evaluating CLNM in PTCs. The nomogram, as a clinical predictive model, is able to provide an effective evaluation of CLNM risk in PTC patients preoperatively.