Abstract
PURPOSE: We aimed to evaluate preoperative diffusion-weighted magnetic resonance imaging (DWI) for predicting aggressive histological features in papillary thyroid cancer (PTC). METHODS: This prospective study included 141 PTC patients, who underwent DWI prior to thyroidectomy; 88 patients with 88 PTC lesions were finally analyzed. Multiple comparisons of mean and minimum apparent diffusion coefficient (ADC) values (ADCmean and ADCmin) and ADC of the solid component (ADCsolid) between the lowly aggressive PTC, highly aggressive PTC without hobnail, and hobnail variant PTC groups were performed by one-way ANOVA or the Welch test. The nonparametric Kruskal-Wallis H-test was used to assess lesion size differences. Receiver-operating characteristic (ROC) curve analysis was also performed. RESULTS: ADC values in the lowly aggressive PTC group were found to be significantly higher than those in the highly aggressive PTC without hobnail group (ADCmean: 1.35±0.20×10-3 mm2/s vs. 1.16±0.17×10-3 mm2/s, P = 0.003; ADCmin: 1.10±0.17×10-3 mm2/s vs. 0.88±0.16×10-3 mm2/s, P < 0.001; ADCsolid: 1.26±0.23×10-3 mm2/s vs. 1.04±0.17×10-3 mm2/s, P < 0.001). No significant differences for the ADCmean, ADCmin, and ADCsolid were observed between the lowly aggressive and hobnail variant PTC groups (all P > 0.05). Lesion sizes in the hobnail variant PTC group was significantly elevated compared with the lowly aggressive PTC group (2.19±1.21 cm vs. 0.93±0.37 cm, P < 0.001). Areas under the curves (AUCs) for ADCmean, ADCmin, and ADCsolid between the lowly aggressive PTC and highly aggressive PTC group without hobnail were 0.758, 0.851, and 0.787, respectively. The AUC for size between the lowly aggressive and hobnail variant PTC group was 0.896. CONCLUSION: ADCmin from DWI could potentially provide quantitative information to differentiate lowly aggressive PTC from highly aggressive PTC lesions without hobnail variants.