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Nodal staging in recurrent thyroid cancer

Case Study
Vandecaveye, Vincent, M.D., Ph.D. University Hospitals Leuven • Belgium
De Keyzer, Frederik, M.Sc. University hospitals Leuven • Belgium

Patient history

This patient underwent thyroidectomy 2 years ago for small papillary thyroid cancer. Follow-up ultrasound shows non-vascularized nodule anterior to the trachea. Clinically there is a slight elevation of the tumor marker.

MR examination

Ingenia 3.0T with dSHeadNeckSpine coil solution is used to scan the entire head and neck from skull base to thoracic inlet.
Our routine head-neck tumor protocol was used covering the entire head and neck from skull base to thoracic inlet. It includes:
 
Pre-contrast T2- and T1-weighted in transverse orientation;
SPAIR-DWI with 6 b-values ranging from b0 to b1000 for nodal staging using ADC;
Post-contrast 4D-THRIVE and transverse T1-weighted TSE (coronal and/or sagittal if needed, depending on lesion location and clinical need).

ExamCard used:

Images

 Ultrasound T2W
Ultrasound
T2W
 DWI b1000 4D-THRIVE Initial slope map
DWI b1000
4D-THRIVE
Initial slope map


Ultrasound shows a non-vascularized node anterior to the trachea. The node is heterogeneously intense on the T2-weighted image and clearly hyperintense at b1000 DWI. It has a calculated ADC b500-1000 (cellular fraction) of 0.68 10-3 mm2/sec, so suspect for metastasis. 4D-THRIVE shows early arterial enhancement in the node. The hypervascularity is confirmed by calculation of the initial slope map, where the node is red indicating rapid arterial enhancement.

Diagnosis

Findings suggest recurrence of papillary thyroid cancer presenting as an abnormal node anterior to the trachea in level VII. This was proven by histopathology after surgery.

Clinical impact of Ingenia 3.0T MR imaging

Ingenia 3.0T with dSHeadNeckSpine coil solution is used to scan the entire head and neck from skull base to thoracic inlet. DWI and 4D-THRIVE improve lesion conspicuity, and provide additional information to help in node characterization and help differentiation of post-radiotherapy necrosis and inflammation from tumor recurrence.


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Nov 5, 2013

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Case Study
Ingenia 3.0T
Release 4
dSHeadNeckSpine coil, dStream, DWI, Head, Neck, Neuro, Oncology, THRIVE
 

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