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ULTRASOUND IN THYROID LESIONS,[object Object],1,[object Object],DR RAJ BUMIYA,[object Object],First Year Resident,[object Object],Dept. of Radiodiagnosis,[object Object],S.S.G. Hospital, Baroda.,[object Object],24/03/2011,[object Object]
      Clinical applications of high resolution usg. ,[object Object],Detection of thyroid and other cervical masses before ,[object Object],and after thyroidectomy.,[object Object],2.   Differentiation of benign from malignant ,[object Object],      masses.,[object Object],Ultrasound detects the presence, size,,[object Object],      site, number, characteristics of thyroid nodules . ,[object Object],3. FNA Guidance,[object Object],2,[object Object]
Technique,[object Object],With high frequency transducer(7.5 to 15Mhz),[object Object],Examination-supine position with neck extended.,[object Object],A small pad may be placed under the shoulders to provide better exposures of neck.,[object Object],Lower pole imaging is enhanced– by asking the pt. to swallow, so the gland moves upward.,[object Object],Examined thoroughly in transverse and longitudinal planes.,[object Object],3,[object Object]
Multiple oblique and angled projections may be taken if necessary.,[object Object],Examined: ,[object Object],SUPERIORLY: to identify Submandibularadenopathy,[object Object],INFERIORLY : to identify Supraclavicularadenopathy,[object Object],4,[object Object]
Normal ultrasound anatomy of thyroid,[object Object],It is located anterior and lateral to trachea below the level of thyroid cartilage and above the sternal notch. (infrahyoid compartment),[object Object],DIVISION : ,[object Object],[object Object]
ISTHMUS
PYRAMIDAL LOBE   (10-40 %)5,[object Object]
6,[object Object],Normal thyroid parenchyma has homogenous medium to high level echogenicity & bounded by a thin hyperechoic line(the thyroid capsule).,[object Object],Landmarks to be identified:,[object Object],Midline -Trachea and oesophagus.,[object Object],Laterally- Common Carotid artery, IJV ,[object Object],Anterolaterally:Strap muscles of the neck,[object Object]
The superior thyroid Vessels are found at upper pole of each lobe and inferior thyroid vein is found at lower pole whereas the inferior thyroid artery is located posterior to lower third of each lobe.,[object Object],7,[object Object]
Anteriorly-Sternohyoid & omohyoid muscles, ,[object Object],                  As hypoechoic bands.,[object Object],Lateral- Sternocleidomastoid,[object Object],                  As large oval band ,[object Object],Posterior- Longus colli muscle ,[object Object],Recurrent laryngeal nerve & inferior thyroid artery pass in the angle between trachea, oesophagus & thyroid lobe.,[object Object],On longitudinal scans, recurrent laryngeal nerve & inferior thyroid artery may be seen as hypoechoic bands between the thyroid lobe & oesophagus on left , thyroid lobe & longus colli on right.,[object Object],8,[object Object]
Oesophagus –,[object Object],laterally & towards the left           ,[object Object],Target appearance on transverse plane,[object Object], Peristaltic movements On swallowing.,[object Object],Trachea ,[object Object],Posteriorly,[object Object],Identified by lack of sound transmission and ring down artifacts.,[object Object],9,[object Object]
10,[object Object]
11,[object Object]
Inferior thyroid artery along the posterior surface,[object Object],12,[object Object],Inferior thyroid vein branches,[object Object],seen at the lower pole,[object Object]
NORMAL DIMENSIONS OF THYROID LOBES,[object Object],A-PLENGTH,[object Object],NEWBORN         	8-9mm    	  	18-20mm,[object Object],INFANT            	12-15mm   		 25mm,[object Object],ADULT            		13-18mm    		40-60mm,[object Object],Normal Mean Thyroid Volume (LxWxTHICKNESSx0.52) : 18.6±4.5,[object Object],MALE-UPTO 23gm IS NORMAL,[object Object],FEMALE- UPTO 22gm IS NORMAL.,[object Object],Mean thickness of isthmus – 4 to 6mm,[object Object],A-P diameter is most precise because relatively independent of possible dimensional asymemetry between two lobes.,[object Object],When AP diameter- > 2cm --- Enlarged gland.,[object Object],13,[object Object]
CONGENITAL ABNORMALITIES,[object Object],AGENESIS/HYPOPLASIA,[object Object],ECTOPIC,[object Object],14,[object Object]
EMBRYOLOGY,[object Object],Thyroid gland is originated from epithelial cells of floor of pharynx.,[object Object],It descends from pharynx & remains connected to pharynx through a tract,known as thyroglossal duct.,[object Object],The gland reaches to its normal location by 7 weeks of gestational age.,[object Object],Then after duct involutes.,[object Object],15,[object Object]
16,[object Object]
17,[object Object],THYROID AGENESIS,[object Object],USG : Abnormal echogenic tissue in the expected location of the thyroid, without any normal flow on color Doppler imaging. There is no evidence of ectopic thyroid tissue. Pertechnetatescintigraphy demonstrates no functioning thyroid tissue. ,[object Object]
Sonography of the thyroid in this 1 yr. old female child revealed congenital absence of the entire thyroid. Note the empty fossae where the right and left lobes would normally lie. The carotid artery and jugular vein of both sides are seen in the color doppler images. These ultrasound and color doppler images suggest congenital agenesis of the thyroid.,[object Object],18,[object Object]
                     ECTOPIC THYROIDThe thyroid gland develops as a median angle from a   diverticulum of the foramen cecum.Normally, it descends to its typical location anterior to the cervical trachea via the thyroglossal duct. Anomalies of descent can lead to a lingual or sublingual position of the gland.Nuclear medicine scintigraphy with sodium iodine-123 or pertechnetate-99m is used to evaluate the neck for the presence of thyroid tissue.Diagnosis of lingual thyroid is made when uptake is seen at the tongue base but not in the thyroid bed.Further evaluation can be done using CT & MRI imaging.,[object Object],19,[object Object]
20,[object Object],CT image- round mass at tongue base which enhances after contrast administration.  A pertechnetate-99m scan shows uptake corresponding to mass at tongue base without uptake in the thyroid bed. ,[object Object]
Thyroid disorders,[object Object],Thyroid disorders can be divided into ,[object Object],Nodular thyroid disease ,[object Object],Diffuse thyroid disease.,[object Object],21,[object Object]
Nodular thyroid disease,[object Object],Hyperplasia and goiter,[object Object],Adenoma,[object Object],Carcinoma,[object Object],Lymphoma,[object Object],Metastases,[object Object],22,[object Object]
Hyperplasia and Goitre:,[object Object],Etiology:,[object Object],Iodine deficiency, dishormonogenesis(familial),poor utilization of Iodine.,[object Object],F:M-3:1 ,more between 35-50 years.,[object Object],Hyperplasia leads to an overall increase in size or volume of the gland.,[object Object],Hyperplastic nodules often undergo liquefactive degeneration with the accumulation of blood, serous fluid and colloid substance, reffered to as hyperplastic,adenomatous, or colloid nodules.,[object Object],Coarse and perinodular calcification occur.,[object Object],23,[object Object]
Sonography,[object Object],Most   hyper plastic or adenomatous nodules are isoechoic compared to normal thyroid tissue.,[object Object],As Size of the mass increases, it may become hyperechoic.,[object Object],Less frequently hypo echoic SPONGE—like OR HONEY COOMB CYSTIC pattern is seen.,[object Object],When nodule is hyperechoic or isoechoic, a thin peripheral hypoechoic halo is commonly seen-due to perinodular blood vessels and edema or compression of adjacent normal parenchyma.,[object Object],Perinodular, intranodular vascularity on colour Doppler.,[object Object],DEGENERATIVE CHANGES:,[object Object],Purely anechoic -due to serous/colloid fluid.,[object Object],Echogenic fluid/moving fluid-fluid levels due to hemorrhage.,[object Object],Bright echogenic foci with comet tail artifacts due to dense colloid material/microcrystals.,[object Object],Eggshell(thin peripheral) or coarse calcification.,[object Object],24,[object Object]
25,[object Object],Sonogram of the left lobe of the thyroid gland in the transverse plane,[object Object], showing a rounded lobe of a goiter. L=enlarged lobe, I= widened ,[object Object],isthmus,T=trachea,C=carotid artery,J=jugular vein,,[object Object], S=Sternocleidomastoid muscle, m=strap muscles, E=esophagus.,[object Object]
Hyperplastic nodules,[object Object],Oval homogenous isooechoic nodule with well defined  peripheral halo.,[object Object],Multiple hyperechoic nodules,[object Object],26,[object Object]
Cystic degenerative changes in  adenomatous nodules,[object Object],27,[object Object]
Adenoma ,[object Object],F:M – 7:1,[object Object],Solitary or as a part of multinodular goiter.,[object Object],Sonography,[object Object],Hyperechoic, iso or hypoechoic solid masses .,[object Object],Have Peripheral hypoechoic halo which is thick & smooth- due to fibrous capsule and blood vessels.,[object Object],Typical spoke and wheel type of appearance on color doppler.,[object Object],D/D : FOLLICULAR CARCINOMA— where vascular and capsular invasion are hallmarks.,[object Object],28,[object Object]
Isoechoic solid mass with thick irregular complete halo. Power doppler – spoke and wheel like appearance FOLLICULAR ADENOMA,[object Object],29,[object Object]
30,[object Object],multiple nodular densities in cervical region that are palpable on physical examination.CT scan obtained 9 months before sonogram shows absent left thryoid lobe and enlarged right thryoid lobe with small low-attenuation lesion. ,[object Object]
Carcinoma:,[object Object],Most primary thyroid cancers are of epithelial origin and are derived from either the follicular or the parafollicularcells.Most are well differentiated.,[object Object],Papillary carcinoma- 75-90% . ,[object Object],Medullary/Follicular/anaplastic car. -10-25%,[object Object],Papillary cancer,[object Object],3rd and 7thdecade.F>M,[object Object],The major route of spread is through lymphaticsto nearby cervical lymph nodes.,[object Object],Distant metastasis is rare (2-3%) and occurs to mediastinum and lungs.,[object Object],HISTOLOGY: PSAMMOMA BODIES,[object Object],31,[object Object]
Sonography,[object Object],Hypoechoic nodules with microcalcifications,[object Object],(tiny punctuate hyperechoic foci with or without acoustic shadowing). ,[object Object],Disorganized hypervascularity on color doppler,Mostly in well encapsulated form. ,[object Object],Cervical lymphnodemetatasis which may contain tiny punctateechogenic foci due to microcalcifications. ,[object Object],Cystic lymph node metatasis in neck occur almost exclusively with papillary carcinoma.,[object Object],32,[object Object]
Hypoechoic solid nodule with punctate calcification,[object Object],33,[object Object],Isoechoic nodule & punctateechogenic foci within it,[object Object]
Two rounded hypoechoic nodes – typical of metastasis to cervical nodes,[object Object],34,[object Object],Hetrogenous oval nodes containing microcalcifications,[object Object]
[object Object],35,[object Object]
36,[object Object],Punctate echogenicities in thyroid nodules. (a) Sagittal US image of nodule containing multiple fine echogenicities with no comet-tail artifact. These are highly suggestive of malignancy.FNA and surgery confirmed papillary carcinoma. (b) Transverse US image of nodule  containing cystic areas with punctate echogenicities and comet-tail artifact  consistent with colloid crystals in a benign nodule. ,[object Object]
37,[object Object],Role of color Doppler US. (a) Transverse gray-scale image of ,[object Object],Predominantly solid thyroid nodule (b) Addition of color Doppler modeshows marked internal vascularity,indicating increased likelihood,[object Object], that nodule is malignant. This was a papillary carcinoma. ,[object Object]
38,[object Object]
Follicular Carcinoma,[object Object],5 -15% (2 variants-widely invasive and minimally invasive),[object Object],Hematogenousspread to bone/lung/brain/liver,[object Object],Sonography:Cant be differentiated from follicular adenoma,[object Object],So treatment for both is surgical excision.,[object Object],Hypoechoic nodule with irregular tumor margins,[object Object],Thick, irregular halo.,[object Object],Tortuous or chaotic arrangement of internal blood vessels on color doppler.,[object Object],PATHOLOGY: Vascular &  capsular invasion.,[object Object],39,[object Object]
Heterogenous solid mass with peripheral and internal flow – follicular carcinoma,[object Object],40,[object Object]
Medullary Carcinoma,[object Object],only 5 % thyroid cancer. ,[object Object],Derived from parafollicular or C cells ,[object Object],secretes calcitonin.- useful serum marker.,[object Object],Frequently familial and Associated with MEN II syndrome.,[object Object],Bilateral in 90% of familial cases.,[object Object],High incidence of metastatic to lymphnodes.,[object Object],Sonography,[object Object], - Similar to papillary carcinoma-hypoechoic solid mass with calcifications(often, but coarse than papillary carcinoma).,[object Object], -Local invasion and cervical lymphadenopathy are also more common.,[object Object],41,[object Object]
42,[object Object],Heterogenous nodule with multiple punctate foci of ,[object Object],calcification within it – medullary carcinoma,[object Object],Isoechoic nodule & punctate,[object Object],echogenic foci within it,[object Object]
Longitudnal color and power doppler – intranodular hypervascularity,[object Object],43,[object Object]
Anaplastic thyroid carcinoma,[object Object],Occurs in elderly,[object Object], < 5% tumors ,[object Object],worst prognosis,[object Object],Presents as a rapidly enlarging mass extending beyond gland and invading adjacent structures. ,[object Object],Show aggressive local invasion of muscle and vessels.,[object Object],Sonography,[object Object],   Hypoechoic masses often seen to encase or invade blood vessel and neck muscles(CT or MRI demonstrates the tumor more accurately  owing to their large size) .,[object Object],44,[object Object]
Longitudnal scan – solid hypoechoic mass extending into the upper mediastinum – anaplastic carcinoma,[object Object],45,[object Object]
46,[object Object],Aggressive thyroid cancer in left neck with spread to lungs ,[object Object]
Lymphoma,[object Object],4% of all thyroid malignancies.,[object Object],Mostly non-Hodgkin’s type,[object Object],Elder females ,[object Object],In 70-80% cases arises from pre-existing chronic lymphocytic thyroiditis(HASHIMOTO’S thyroiditis) with subclinical or overt hypothyroidism.,[object Object],Sonography,[object Object],Markedly Hypoechoic lobulated mass .,[object Object],Hypovascular or show blood vessels with chaotic distribution and arteriovenous shunts.,[object Object],Large areas of cystic necrosis may occur as well as encasement of adjacent neck vessels. ,[object Object],Adjacent thyroid parenchyma heterogenous due to associated chronic thyroiditis.,[object Object],47,[object Object]
Nodule within a cystic lesion. No flow within the nodule,[object Object],48,[object Object]
49,[object Object],Isotope scan of thyroid demonstrating a photopenic area within the left lobe.,[object Object],  Axial contrast enhanced CT of the same patient shows a solid mass within left lobe of thyroid . Lymphoma was proven by biopsy. ,[object Object]
Differentiation ,[object Object],50,[object Object]
51,[object Object]
+  rare (<1%),[object Object],++  low probability (<15%),[object Object],+++  intermediate probability(16 to 84%),[object Object],++++ high probability (>85%),[object Object],52,[object Object]
53,[object Object],Sagittal image of predominantly cystic nodule (calipers), which proved to be benign at cytologic examination. ,[object Object],Sagittal image of predominantly ,[object Object],solid nodule , which proved to be ,[object Object],benign at cytologic examination.,[object Object]
Transverse US images of mostly cystic thyroid nodule with a mural component containing flow. (a) Gray-scale image shows predominantly cystic nodule  with small solid-appearing mural component  (b) Addition of color Doppler mode demonstrates flow within mural component , confirming that it is tissue and not debris. US-guided FNA can be directed into this area. The lesion was benign at cytologic examination. ,[object Object],54,[object Object]
Peripheral coarsecalcification with   acoustic shadowing –  favours benign nature,[object Object],55,[object Object],Peripheral egg shell calcification,[object Object]
56,[object Object],HYPERPLASTIC,[object Object], NODULAR,[object Object],Iso/hyperechoic,[object Object],hypoechoic-honey,[object Object],coomb,[object Object],Thin peripheral halo,[object Object],Peri & intranodular,[object Object],vascula.,[object Object],ADENOMA,[object Object],Hyper/iso/hypoechoic,[object Object],Thick peripheral halo,[object Object],Spoke wheel ,[object Object],Appearance,[object Object],LYMPHOMA,[object Object],Elder,[object Object],NHL,[object Object],Dyspnoea,Dysphagia,[object Object],Hashimoto’s,[object Object],thyroditis,[object Object],Hypovascular/chaotic,[object Object],vasc.,[object Object],METS,[object Object],Homogenous,[object Object], Hypoechoic,[object Object],No calcification,[object Object],Primary-Rcc/breast/,[object Object],Melanoma,[object Object],CARCINOMA,[object Object],PAPILARY,[object Object],3RD,7TH Decade,[object Object],Psammoma bodies,[object Object],Cervical LN,[object Object],HYPERECHOIC ,[object Object], PUNCTATE,[object Object],CALCIFICATION,[object Object],Disorganised,[object Object],hypervascularity,[object Object],Cystic LN Mets,[object Object],FOLLICULAR,[object Object],Hyperechoic,[object Object],Thick irregular,[object Object], halo,[object Object],Tortous vessels,[object Object],Hematogenous,[object Object],spread,[object Object],To,[object Object],Bone/lung/,[object Object],brain/liver,[object Object],MEDULARY,[object Object],Famillial,[object Object],MEN type-2,[object Object],Calcitonnin,[object Object],LN METS-HIGH,[object Object],HYPOECHOIC,[object Object],COARSE ,[object Object],CALCIFICA,[object Object],ANAPLASTIC,[object Object],Elder,[object Object],Aggressive,[object Object],Invasion=,[object Object],muscles,vessels,[object Object],Worst prognosis,[object Object]
Evaluation of nodules incidentally detected by sonography,[object Object],Nodules<1.5cm : followed by palpation at time of next physical examinaton,[object Object],Nodules > 1.5cm : evaluation usually by FNA,[object Object],Any nodule with malignant features like–microcalcifications, irregular margin , thick halo , or internal flow: FNA,[object Object],57,[object Object]
Biopsy guidance,[object Object],    INDICATIONS,[object Object],[object Object]
Patients at high risk of developing thyroid cancer, normal gland by physical examination but sonography demonstrates a nodule.
Previous non diagnostic / inconclusive biopsy. 58,[object Object]
59,[object Object]
60,[object Object]
DIFFUSE THYROID DISEASE,[object Object],1.THYROIDITIS ,[object Object],CHRONIC AUTOIMMUNE ,[object Object],LYMPHOCYTIC THYROIDITS,[object Object],(HASHIMOTO’S THYROIDITIS),[object Object],ACUTE SUPPURATIVE,[object Object], THYROIDITIS,[object Object],INVASIVE ,[object Object],FIBROUS,[object Object],THYROIDITIS,[object Object],SUBACUTE GRANULOMATOUS,[object Object], THYROIDITIS,[object Object],(DE QUERVAIN’S DISEASE),[object Object],SILENT/,[object Object],PAINLESS,[object Object], THYROIDITIS,[object Object],2.ADENOMATOUS OR COLLOID GOITRE,[object Object],3. GRAVE’S DISEASE,[object Object]
Diffuse Thyroid disease,[object Object],Characterised by Generalized enlargement of gland and no palpable nodules.,[object Object],Diagnosis is usually based on clinical and laboratory finding and occasion by FNA.,[object Object],Sonography helpful when underlying disease causes asymmetric thyroid enlargement. ,[object Object],Sonographic diagnosis of diffuse thyroid disease is made when isthmus may be up to 1 cm or more thickness.,[object Object],62,[object Object]
Diffuse enlargement of the isthmus and both lobes,[object Object],63,[object Object],Diffuse enlargement – heterogenous gland with multiple nodules,[object Object]
ACUTE  SUPPURATIVE  THYRODITIS,[object Object],Rare inflammatory disease caused by bacteria affecting children.,[object Object],Sonography useful in selected cases to detect thyroid abscess-ill defined hypoechoic mass with debris and/or septa and gas.,[object Object],SUBACUTE GRANULOMATOUS THYROIDITIS(DE QUERVAIN’S),[object Object],Spontaneously remitting inflammatory disease probably caused by viral infection.,[object Object],C/F :fever, enlargement of gland ,Tenderness ,[object Object],Sonography – enlarged hypoechoic gland with normal or decreased vascularity due to edema.,[object Object],64,[object Object]
Ill defined hypoechoic area – focal area of subacutethyroiditisresolved after 4 wks of medical therapy,[object Object],65,[object Object]
66,[object Object],Sagittal sonogram of left lobe of thyroid shows solid,,[object Object], predominately hyperechoic, poorly marginated nodule in lower pole corresponding to palpable abnormality.Fine-needle aspiration of this lesion  was consistent with thyroiditis.Background of thyroid was heterogeneous,with geographic regions of hypoechogenicity. ,[object Object]
Chronic autoimmune lymphocytic (Hashimoto’s) thyroiditis,[object Object],As a painless diffuse enlargement of thyroid ,[object Object],often associated with hypothyroidism.,[object Object],genetic tendency . ,[object Object],F:M – 8 : 1 .Young woman are affected.,[object Object],Lymphocytic infiltration of thyroid gland. ,[object Object],Sonography,[object Object],Diffuse coarsened hypoechoic glandular enlargement,[object Object],67,[object Object]
Multiple discrete hypoechoic micronodules,[object Object], of 1-6 mm size is strongly suggestive of chronicthyroiditis.,[object Object],   Surrounded by multiple linear echogenic fibrous septations- giving pseudo lobulated appearance.,[object Object],Normal or hypovascular.Occasionallyhypervascular .,[object Object],Often Cervical lymphadenopathy may be present.,[object Object],In end stage, atrophy of gland occurs when thyroid gland is small with ill defined margins and heterogenousechotexture with absent blood flow.,[object Object],68,[object Object]
Various appearances of Hashimoto’s disease,[object Object],69,[object Object]
70,[object Object],Nodule was predominantly hyperechoic, with both solid and cystic-appearing Fine-needle aspiration of this 28 mm palpable nodule  was consistent with lymphocytic thyroiditis. ,[object Object]
Sagittal sonogram of right lobe obtained at time of diagnosis of left-sided thyroid carcinoma shows 11-mm hypoechoic solid nodule with ill-defined margins (delineated by electronic calipers) in upper pole of right lobe. Sonographically guided fine-needle aspiration of this nodule and surgical pathology findings were consistent with lymphocytic thyroiditis.,[object Object],71,[object Object]
Painless thyroiditis,[object Object],Thyroid enlargement in early phase followed by hypothyroidism.,[object Object],Clinical findings are similar to subacutethyroiditis,[object Object],Histologic and sonographic pattern of chronic autoimmune thyroiditis.,[object Object],72,[object Object]
Graves disease,[object Object],Diffuse abnormality of thyroid gland with associated thyrotoxicosis,[object Object],Sonography,[object Object],Diffusely hypoechoic or inhomogenous texture ,[object Object],Color Doppler shows hypervascular pattern known as “thyroid inferno”. ,[object Object],Spectral Doppler shows peak velocities exceeding 70cm/sec.,[object Object],73,[object Object]
74,[object Object]
75,[object Object],Graves’ disease – diffuse hypervascularity and ,[object Object],           peak systolic velocity of 80cmec,[object Object]
76,[object Object],Pinhole images from a Tc-99m pertechnetate thyroid exam demonstrate diffuse thyroid enlargement with decreased background activity. ,[object Object]
Invasive fibrous thyroiditis(Riedel’s struma),[object Object],Female,[object Object],Tends to progress to complete destruction,[object Object],USG,[object Object],    Diffusely enlarged thyroid gland,[object Object],Inhomogenousparenchymal echo texture,[object Object],   May have associated mediastinal or retroperitoneal fibrosis or sclerosingcholangitis.,[object Object],D/D : From Anaplastic thyroid carcinoma….by biopsy.,[object Object],77,[object Object]
Role of CT and MRI in thyroid disorders,[object Object],To demonstrate- Extent of local invasion ,[object Object],                         - regional LN metastasis,[object Object],To determine recurrence following Surgery.,[object Object],Detection of retrosternal & retrotracheal extension of the thyroid enlargement.,[object Object],Confirm the location of mass within the gland, evaluating nodal disease and assessing the airway.,[object Object],78,[object Object]
 CT signs suggesting the thyroid origin of mediastinal mass include,[object Object],Intimate association of the superior pole of mass with thyroid gland & close proximity to the trachea.,[object Object],Hyperdensity of lesion compared to surrounding tissue.,[object Object],Presence of calcification.,[object Object],Persistent enhancement of the mass.,[object Object],79,[object Object]
Differentiation of benign and malignant primary thyroid masses is impossible on imaging, although the associated lymphadenopathy, vocal cord paralysis and bone or cartilage invasion obviously suggests malignancy.,[object Object],MRI helps to differentiate scar from residual or recurrent tumor.,[object Object],Tumor - hypointense to isointense on T1WI,[object Object],               iso to hyperintense on T2WI,[object Object], scar - hypointense on both T1 and T2WI.,[object Object],80,[object Object]
81,[object Object]
GOITER -Enhancing heterogenous soft tissue mass orignated in thyroid and causing deviation of the trachea,[object Object],82,[object Object],Large heterogenous soft tissue mass replacing the thyroid with speck of calcification,causing deviation of the trachea–medullary carci.,[object Object]
Cystic metastasis from thyroid carcinoma,[object Object],83,[object Object]
Role of radionuclide thyroid scintigraphy,[object Object],To determine functional status of the nodules.,[object Object],Nodules may be cold, warm or hot depending on the uptake of tracer as compared to the normal thyroid tissue.,[object Object],Thyroid nodules concentrate less radioiodine (only 1%) than normal thyroid tissue  hence appear cold.,[object Object],Most cold nodules are adenomas, colloid nodules or foci of thyroiditis or rarely intrathyroid lymphnodes, lymphoma or metastases.,[object Object],84,[object Object]
Approximately 10 to 20 % of cold solitary thyroid nodules are malignant.,[object Object],Cold nodules further require FNAC or biopsy.,[object Object],The demonstration of hot nodule on scintigraphy is not synonymous with autonomy, as it often represents spared focus of normal thyroid tissue in gland otherwise involved in destructive process.,[object Object],The more important role is of 131 I whole body scintigraphy to identify most functioning metastases, usually in the neck, lungs or bone, following total thyroidectomy.,[object Object],85,[object Object]
86,[object Object]
[object Object],                                                                                                            UPTAKE,[object Object],   HASHIMOTO’S           HYPOECHOIC,[object Object],   THYROIDITIS                   COARSENED                                         VARIABLE,[object Object],MICRONODULATION,[object Object],   SUBACUTE                      HYPOECHOIC,[object Object],  GRANULOMATOUS           N/HYPOVASCULAR                             DECREASED,[object Object],  GRAVE’S DISEASE        INHOMOGENOUS                           INCREASED ,[object Object],                                           HYPERVASCULAR        ,[object Object],INVASIVE FIBROUS           INHOMOGENOUS                                 VARIABLE,[object Object],EXTRATHYROID INFLAMMATION,[object Object],                                          VESSEL ENCASEMENT,[object Object],87,[object Object]
MCQs,[object Object],88,[object Object]
89,[object Object],1. GIVE THE DIAGNOSIS,[object Object]
2. Egg cell calcifications are more common in which type of tumor?,[object Object],90,[object Object]

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DR RAJ BUMIYA'S THYROID LESIONS USG - ULTRASONOGRAPHY

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