title: Differentiation between Graves' disease and painless thyroiditis by diffusion-weighted imaging, thyroid iodine uptake, thyroid scintigraphy and serum parameters.
abstract: The aim of the present study was to assess the apparent diffusion coefficient (ADC) in diffusion-weighted imaging (DWI), thyroid radioactive iodine uptake (RAIU), thyroid scintigraphy and thyrotropin receptor antibody (TRAb) levels in the differential diagnosis between Graves' disease (GD) and painless thyroiditis (PT). A total of 102 patients with GD and 37 patients with PT were enrolled in the study. DWI was obtained with a 3.0-T magnetic resonance scanner, and ADC values were calculated. RAIU and thyroid scintigraphy were performed. Tissue samples were obtained from patients with GD (6 cases) following thyroidectomy, and from patients with PT (2 cases) following biopsy. Receiver operating characteristic (ROC) curves were drawn, optimal cut-off values were selected, and the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were assessed. It was found that the ADC, TRAb and RAIU were significantly higher in GD than in PT (P<0.05). ROC curves showed areas under the curves for RAIU, ADC and TRAb that were >0.900. RAIU was the reference method. Sensitivity, specificity, accuracy, PPV and NPV were 96.078, 91.892, 95.000, 97.059 and 89.474% for ADC, and 88.235, 75.676, 84.892, 90.909 and 70.000% for TRAb, after the optimal thresholds of 1.837×10-3mm2/sec and 1.350 IU/ml were determined respectively. Histopathology showed that tissue cellularity in PT was much higher than in GD due to massive lymphocytic infiltration. The results of the present study indicate that RAIU, ADC and TRAb are of diagnostic value for differentiating between GD and PT. DWI has great potential for thyroid pathophysiological imaging because it reflects differences in tissue cellularity between GD and PT.
authors.affiliation: Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China.
authors.forename: Zhaowei
authors.initials: Z
authors.lastname: Meng
authors.affiliation: Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China.
authors.forename: Guizhi
authors.initials: G
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China.
authors.forename: Haoran
authors.initials: H
authors.lastname: Sun
authors.affiliation: Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China.
authors.forename: Jian
authors.initials: J
authors.lastname: Tan
authors.affiliation: Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China.
authors.forename: Chunshun
authors.initials: C
authors.lastname: Yu
authors.affiliation: Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China.
authors.forename: Weijun
authors.initials: W
authors.lastname: Tian
authors.affiliation: Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China.
authors.forename: Weidong
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China.
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China.
authors.forename: Mei
authors.initials: M
authors.lastname: Zhu
authors.affiliation: Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China.
authors.forename: Qing
authors.initials: Q
authors.lastname: He
authors.affiliation: Department of Pathology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China.
authors.forename: Yujie
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China ; Department of Radiology, Second Affiliated Hospital of Zhejiang Medical University, Hangzhou, Zhejiang 310000, P.R. China.
authors.forename: Shugao
authors.initials: S
authors.lastname: Han
keywords: Graves' disease; apparent diffusion coefficient; diffusion-weighted magnetic resonance imaging; painless thyroiditis; thyroid radioactive iodine uptake; thyroid scintigraphy; thyrotropin receptor antibody