There may be a role for this cross-sectional imaging modality if the nodule is part of a goiter that is suspected to extend substernally or there is a suspicion of invasive thyroid cancer. Dual- phase CT imaging with and without IV contrast does not provide any additional information. MRI Neck There is no evidence that MRI can differentiate between malignant and benign nodules unless there is gross invasion or metastatic disease. There may be a role for this cross-sectional imaging modality if the nodule is part of a goiter that is suspected to extend substernally or there is a suspicion of invasive thyroid cancer. CT is preferred since there is less respiratory motion artifact. FDG-PET/CT Whole Body There is no evidence to support the use of PET using the tracer fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)/CT in the setting of palpable thyroid nodule. Radionuclide Uptake and Scan In euthyroid patients, radioisotope scanning is not helpful in determining malignancy and decision to biopsy. Although cold nodules are more likely to be malignant, the majority of nodules are cold, and the majority of cold nodules are benign, resulting in a low positive predictive value. Variant 2: Suspected goiter. Initial imaging. A goiter is suspected based on a diffuse palpable abnormality or obstructive symptoms, such as dyspnea, orthopnea, obstructive sleep apnea, dysphagia, and dysphonia. These symptoms are related to mass effect on the trachea or esophagus. Thyroid Disease The role of imaging is to confirm the diagnosis of goiter and document the size and extent of the goiter. If obstructive symptoms are present, imaging can quantify the degree of compression on the trachea. This information is valuable in deciding if surgery will improve obstructive symptoms and planning operative approach. US Thyroid US is the preferred first-line imaging modality for suspected goiter. It confirms that the neck mass is arising from the thyroid and characterizes the size and morphology of the goiter.
Thyroid Disease. There may be a role for this cross-sectional imaging modality if the nodule is part of a goiter that is suspected to extend substernally or there is a suspicion of invasive thyroid cancer. Dual- phase CT imaging with and without IV contrast does not provide any additional information. MRI Neck There is no evidence that MRI can differentiate between malignant and benign nodules unless there is gross invasion or metastatic disease. There may be a role for this cross-sectional imaging modality if the nodule is part of a goiter that is suspected to extend substernally or there is a suspicion of invasive thyroid cancer. CT is preferred since there is less respiratory motion artifact. FDG-PET/CT Whole Body There is no evidence to support the use of PET using the tracer fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)/CT in the setting of palpable thyroid nodule. Radionuclide Uptake and Scan In euthyroid patients, radioisotope scanning is not helpful in determining malignancy and decision to biopsy. Although cold nodules are more likely to be malignant, the majority of nodules are cold, and the majority of cold nodules are benign, resulting in a low positive predictive value. Variant 2: Suspected goiter. Initial imaging. A goiter is suspected based on a diffuse palpable abnormality or obstructive symptoms, such as dyspnea, orthopnea, obstructive sleep apnea, dysphagia, and dysphonia. These symptoms are related to mass effect on the trachea or esophagus. Thyroid Disease The role of imaging is to confirm the diagnosis of goiter and document the size and extent of the goiter. If obstructive symptoms are present, imaging can quantify the degree of compression on the trachea. This information is valuable in deciding if surgery will improve obstructive symptoms and planning operative approach. US Thyroid US is the preferred first-line imaging modality for suspected goiter. It confirms that the neck mass is arising from the thyroid and characterizes the size and morphology of the goiter.