Diagnostic value of diffusion-weighted MR imaging in thyroid disease: application in differentiating benign from malignant disease

Background: Fine needle aspiration biopsy is usually performed to evaluate thyroid lesions. The purpose of this study was to evaluate the usefulness of diffusion weighted imaging to differentiate malignancy of thyroid lesions. Methods: The study was approved by ethics committee of Shanghai Changzheng Hospital. Forty-two patients, 10 men and 32 women (range: 20-72 years, mean age 42.4 years) with thyroid lesions were included in the study. Routine neck MR and diffusion-weighted MR imaging was performed using multiple b-values. ADC values were computed for the different b-values. Histological results of the thyroidectomy samples were obtained for all the patients. ADC values of benign and malignant thyroid lesions were compared with the pathology results. Logistic regression analysis was used to detect independent parameters for differentiating benign and malignancy of lesions. Result: Based on the histology results there were 28 benign and 14 malignant cases. The difference of ADC value between benign and malignant thyroid lesions was significant for ADC values obtained using b-values of 0 and 300 s/mm(2) (p < 0.001). The ADC values were significantly higher in benign lesions (benign ADC: 2.37 +/- 0.47 x 10(-3) mm(2)/s vs. malignant: 1.49 +/- 0.60 x 10-3 mm(2)/s). ADC values obtained with b-values of 0 and 300 mm(2)/s and max nodular diameter was regarded as the two most discriminative parameters for differentiating malignancy. Using the pathology results as a standard reference, area under ROC curve was found to be 0.876 for an ADC cutoff value of 2.17 x 10(-3) mm(2)/s that corresponded to an acquisition with b-values of 0 and 300 mm(2)/s. Conclusion: Diffusion-weighted MR imaging is a promising non-invasive method to differentiate malignancy in thyroid lesions.