Rationale and Objectives
To assess the activity and clinical course of Graves’ disease with diffusion-weighted magnetic resonance (MR) imaging.
Materials and Methods
Fifty-one patients with Graves’ disease and 25 volunteers underwent diffusion MR imaging of the thyroid gland using a single shot echo-planar imaging with b-factor of 0, 300 and 600 second/mm 2 . The apparent diffusion coefficient (ADC) values of the thyroid gland were calculated. Patients with active Graves’ disease included untreated patients at initial diagnosis ( n = 12), patients under antithyroid drugs ( n = 11), and patients in relapse after withdrawal of therapy ( n = 13). Patients with inactive disease had a remission of hyperthyroidism ( n = 15).
Results
The mean ADC values of thyroid gland with active Graves’ disease was 0.65 ± 0.03 × 10 −3 mm 2 /second in patients at initial diagnosis, 0.81 ± 0.02 × 10 −3 mm 2 /second in patients undergoing antithyroid drug and 0.72 ± 0.07 × 10 −3 mm 2 /second in patients with relapse of hyperthyroidism. The mean ADC of patients with remission was 0.94 ± 0.03 × 10 −3 mm 2 /second and for normal volunteer was 1.06 ± 0.08 × 10 −3 mm 2 /second. There was significant difference in the ADC value of patients with active disease and remission ( P = .001). The cutoff ADC value used for differentiating patients with active disease from patients with remission was 0.82 × 10 −3 mm 2 /second. The mean ADC value of thyroid gland had positive correlation with thyroid-stimulating hormone ( r = 0.87, P = .001) and negative correlation with serum T4 ( r = −0.82, P = .001) and serum T3 ( r = −0.71, P = .001).
Conclusions
The ADC value of the thyroid gland is a promising non invasive parameter for diagnosis of different clinical stages of Graves’ disease. Hence it can be used to assess the activity and predict the outcome of patients during and after medical treatment.
Graves’ disease is a chronic autoimmune disorder characterized by a variable clinical course. In patients with Graves’ disease, hyperthyroidism can present a stable state after medical treatment or shows a relapsing or remitting course. This represents a diagnostic challenge to the clinician and radiologist. Accurate determination the clinical course of Graves’ disease, whether remission or relapse is mandatory for the effectiveness of medical treatment or surgical decision making after failure of medical treatment .
The need for an accurate noninvasive easily repeatable diagnostic modality is warranted. Ultrasound with color and power Doppler examination is commonly used for evaluation the activity of Graves’ disease, but there are operator dependence and overlap in the parameters of spectral analysis . Radionuclide scintigraphy is the gold standard for diagnosis of Graves’ disease, but it is associated with radiation exposure . Standard clinical magnetic resonance (MR) imaging has a limited role in thyroid disease because there is no correlation between the signal intensity and the activity of Graves’ disease .
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Materials and Methods
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Results
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Table 1
The Mean, Minimum, and Maximum Apparent Diffusion Coefficient Values (10 −3 mm 2 /second) of the Thyroid Gland in the Different Stages of Graves’ Disease and in Volunteers
Patient Group No. Mean ± SD Minimum Maximum Patient at initial diagnosis 12 0.65 ± 0.03 0.60 0.70 Patient under treatment 11 0.81 ± 0.02 0.78 0.89 Patient with relapse 13 0.72 ± 0.02 0.69 0.78 Patient with remission 15 0.94 ± 0.03 0.80 1.20 Volunteers 25 1.06 ± 0.08 0.95 1.20
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Table 2
The ADC Values and Thyroid Function Tests in Different Stages of Patients with Graves’ Disease and in Volunteers
Patient Group No. ADC Value TSH T3 T4 Patient at initial diagnosis 12 0.65 ± 0.03 2.5 ± 0.4 314.4 ± 64 21.4 ± 2.5 Patient under treatment 11 0.81 ± 0.02 1.4 ± 0.5 202.6 ± 32 11.2 ± 2.9 Patient with relapse 13 0.72 ± 0.02 3.3 ± 0.9 136.4 ± 29 6.97 ± 1.8 Patient with remission 15 0.94 ± 0.03 2.9 ± 0.3 277.7 ± 74 17.8 ± 2.5 Volunteers 25 1.06 ± 0.08 3.1 ± 1.0 132.4 ± 23 6.93 ± 1.7
ADC, apparent diffusion coefficient; TSH, thyroid-stimulating hormone.
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Discussion
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Conclusion
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