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IMAGING OF THE THYROID

IMAGING OF THE THYROID. Dr Jill Hunt Consultant Radiologist West Herts NHS Trust. Imaging techniques. ULTRASOUND Nuclear medicine CT MRI PET/CT. WHO TO SCAN?. Clinical goitre Palpable nodule Cervical lymphadenopathy Thyroid lesions on CT/MRI Thyroid lesions on PET

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IMAGING OF THE THYROID

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  1. IMAGING OF THE THYROID Dr Jill Hunt Consultant Radiologist West Herts NHS Trust

  2. Imaging techniques • ULTRASOUND • Nuclear medicine • CT • MRI • PET/CT

  3. WHO TO SCAN? • Clinical goitre • Palpable nodule • Cervical lymphadenopathy • Thyroid lesions on CT/MRI • Thyroid lesions on PET • Not for hyper/hypothyroid patients without palpable abnormality as general rule

  4. NODULAR THYROID DISEASE • Multinodular goitre • Adenomas • Colloid nodules • Cysts • Tumours – Papillary, Follicular, Anaplastic, Medullary cell, Lymphoma, Metastases • Thyroiditis

  5. DIFFUSE THYROID DISEASE • Grave’s Disease • Hashimoto’s thyroiditis (may be nodular) • Subacute lymphocytic thyroiditis • Subacute viral thyroiditis • Reidel’s thyroiditis • AIT

  6. NODULE ASSESSMENT • (Palpable or impalpable) • Solitary or multiple • Size and shape • Echogenicity +/- cystic change • Definition/halo • Calcifications • Vascularity

  7. THE PROBLEM –WHICH FOR FNA • Prevalence ~ 5% by palpation • Prevalence of clinically inapparent nodules at US ~ 20-75% • 20-48% patients with 1 palpable nodule have additional nodules on US • ~ 5% of thyroid nodules will be malignant • No. of thyroid cancer cases in UK in 2007 - 2108

  8. Benign lesion with spongiform appearance

  9. Colloid nodule

  10. Papillary carcinoma

  11. Anaplastic carcinoma

  12. CLINICALLY SUSPICIOUS FEATURES • Hx of head/neck DXT • FHx of MTC, papillary ca or MEN Type 2 • Age <14 or >70 • Male • Growing nodule • Firm/hard/fixed nodule • Cervical lymphadenopathy • Persistent dysphonia/dysphagia/dyspnoea

  13. NUCLEAR MEDICINE

  14. CT OF THE THYROID

  15. MRI of a papillary carcinoma

  16. CT/PET of the thyroid

  17. CONCLUSION • Ultrasound +/- FNA remains the mainstay of thyroid imaging • Nuclear medicine still has limited role • CT, MRI and CT/PET small number of specific indications

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