Multimodality molecular imaging (FDG-PET/CT, US elastography, and DWI-MRI) as complimentary adjunct for enhancing diagnostic confidence in reported intermediate risk category thyroid nodules on bethesda thyroid cytopathology reporting system

The potential complimentary role of various molecular imaging modalities [fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT), ultrasound (US)-elastography, and  diffusion weighted imaging-magnetic resonance imaging (DWI-MRI)] in characterizing thyroid nodules, which have been designated as "intermediate risk category" on the  Bethesda thyroid cytopathology reporting system (BTCRS), is illustrated in this communication. The clinical cases described (category III thyroid nodules on BTCRS) show the imaging features and  the final diagnostic impressions rendered by the interpreting physicians with the modalities that have been independently compared in a tabular format at the end; of particular note is the high negative predictive value of these (specifically FDG-PET/CT), which could aid in enhancing the diagnostic confidence in the reported "intermediate risk category" thyroid nodules, a "gray zone" from the patient management viewpoint.

Keywords

Diffusion weighted imaging-magnetic resonance imaging (DWI-MRI) - fine-needle aspiration cytology (FNAC) - fluorodeoxyglucose-positron emission tomography/computed tomography ( ¹⁸ F-FDG-PET/CT) - ultrasound (US)-elastography