Transcript Variations of Pulmonary Venous Drainage : Clinical Usefulness of

XIX Symposium Neuroradiologicum
Characteristic Dynamic Enhancement
Pattern of MR imaging
for Malignant Thyroid Tumor
Division of Head & Neck radiology
Department of Radiology
Gachon University, Gil Medical Center
Young Nam Park, M.D., Hee Young Hwang, M.D.
Sung Hee Park, M.D., Hyung-Sik Kim, M.D.
Introduction
BACKGROUND
 Usually thyroid nodules are evaluated by scintigraphy,
ultrasonography and percutaneous needle biopsy.
Current diagnostic methods may not enable accurate
detection of the malignant nature of a thyroid nodule,
especially in multinodular goiter.
 Therefore, new techniques are being investigated to
improve the evaluation of thyroid nodules.
 Dynamic contrast medium enhanced MRI is useful to
differentiate malignant and benign lesions of pituitary gland,
breast, and prostate gland.
Introduction
PURPOSE
 The purpose of this study was as follows
: to determine the characteristic dynamic
enhancement pattern of MR imaging
for malignant thyroid tumor.
M&M
StudyPopulation
Population
Study
 The 8 patients were collected,
who were pathology confirmed malignant thyroid tumor
preoperatively.
(F:M=7:1; mean, 55yrs; range, 22~81 yrs)




5 papillary carcinoma
1 medullary carcinoma
1 follicular carcinoma
1 FNAB proven atypical cell
and multiple metastatic LNs in both neck
 We got the approval from IRB (institutional review board
approval) and obtained informed consent from patients for
each study.
M&M
Imaging Protocols
 3.0-T MR imaging unit, Magnetom Verio
(Siemens Medical Systems, Erlangen, Germany)
 Axial T1-weighted MR images
 Axial fast spin-echo T2-weighted MR image
 Contrast agent-enhanced dynamic T1-weighted
images
 Subtraction image
M&M
Imaging Protocols
 Contrast agent-enhanced dynamic T1WI
 dynamic spin-echo sequence
 Images were obtained immediately after injection (as
precontras scan) and at 1 min 30sec/ 3min/ 4 min 30 sec/ 6
min after injection of Gadovist.
 axial planes with 0.7-mm slice thickness
 a repetition time (TR) of 5.12 ms
 an echo time (TE) of 1.99 ms
Outcomes of dynamic enhancement pattern
, thyroid cancer
Dynamic
enhancement pattern
Delayed
enhancement
Patient number
Percentage
(%)
4 papillary carcinoma
1 medullary carcinoma
75%
1 FNAB proven atypical cell
Early strong
enhancement
Persistently
decreased
enhancement
1 follicular carcinoma
12.5%
1 papillary carcinoma
12.5%
8
100%
 Compared to normal thyroid parenchyma
After injection
1 min 30 sec
3 min
4 min 30 sec
6 min
Male/ 80 years old, FNAB proven atypical cell
After injection
1 min 30 sec
3 min
Female/ 69 years old
4 min 30 sec
Follicular carcinoma
6 min
After injection
1 min 30 sec
3 min
Female/ 50 years old
4 min 30 sec
Papillary carcinoma
6 min
Conclusion
 Although this study has
limitation of small patients population,
the data suggest that delayed enhancement on
enhanced dynamic T1WI is possible
characteristic MR finding of malignant
thyroid tumor
Conclusion
Discussion
 This may be because
, in contrast to common cancers,
but similar to other endocrine neoplasm
such as pituitary and adrenal cortex tumours.
angiogenesis is reduced in thyroid carcinoma
compared with normal tissue.