title: On the utility of quantitative diffusion-weighted MR imaging as a tool in differentiation between malignant and benign thyroid nodules.
abstract: OBJECTIVE
  To evaluate the ability of diffusion-weighted magnetic resonance imaging (DWI) in differentiating malignant thyroid nodules from benign lesions with a meta-analysis.
  
  
  METHODS
  Articles in English and Chinese language relating to the accuracy of DWI for this utility were retrieved. Pooled estimation and subgroup analysis data were obtained by statistical analysis.
  
  
  RESULTS
  A total of seven studies (17 subsets) with 358 patients, who fulfilled all of the inclusion criteria, were considered for the analysis. No publication bias was found (bias = 7.03, P > .05). Methodological quality was relatively high. DWI sensitivity was 0.91 (95% confidence interval [CI], 0.87-0.94) and specificity was 0.93 (95% CI, 0.86-0.96). Overall, positive likelihood ratio was 12.24 (95% CI, 6.47-23.20) and negative likelihood ratio was 0.99 (95% CI, 0.06-0.15). Diagnostic odds ratio was 123.78 (95% CI, 56.85-269.48). The area under the curve of the summary receiver operating characteristic was 0.94 (95% CI, 0.92-0.96). In patients with high pretest probabilities, DWI enabled confirmation of malignant thyroid lesion; in patients with low pretest probabilities, DWI enabled exclusion of malignant thyroid lesion. Worst-case-scenario (pretest probability, 50%) posttest probabilities were 92% and 9% for positive and negative DWI results, respectively.
  
  
  CONCLUSIONS
  A limited number of small studies suggests that quantitative DWI is a reliable diagnostic method for differentiation between benign and malignant thyroid lesions.
authors: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630, Dongfang Road, Pudong, Shanghai 200127, China.
authors: Lian-Ming
authors: LM
authors: Wu
authors: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630, Dongfang Road, Pudong, Shanghai 200127, China.
authors: Xiao-Xi
authors: XX
authors: Chen
authors: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630, Dongfang Road, Pudong, Shanghai 200127, China.
authors: Yu-Lai
authors: YL
authors: Li
authors: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630, Dongfang Road, Pudong, Shanghai 200127, China.
authors: Jia
authors: J
authors: Hua
authors: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630, Dongfang Road, Pudong, Shanghai 200127, China.
authors: Jie
authors: J
authors: Chen
authors: Department of Radiology, Wayne State University, Detroit, Michigan.
authors: Jiani
authors: J
authors: Hu
authors: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630, Dongfang Road, Pudong, Shanghai 200127, China. Electronic address: xujianr@yeah.net.
authors: Jian-Rong
authors: JR
authors: Xu
mesh_terms: D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016606:Thyroid Nodule / Q000473:pathology*; D055815:Young Adult
keywords: Diffusion-weighted imaging; meta-analysis; sensitivity; specificity; thyroid nodule