Thyroid Perfusion Imaging as a Diagnostic Tool in Graves’ Disease – Arterial Spin Labeling Magnetic Resonance Imaging vs. Colour-Coded Doppler Ultrasound

K. Müssig; C. Schraml; R. Rietig; P. Martirosian; N. F. Schwenzer; C. D. Claussen; H.-U. Häring; F. Schick; B. Balletshofer

doi:10.1055/s-0032-1325342

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, Table of Contents

Rofo 2012; 184(12): 1138-1143
DOI: 10.1055/s-0032-1325342

Kopf/Hals

Thyroid Perfusion Imaging as a Diagnostic Tool in Graves’ Disease – Arterial Spin Labeling Magnetic Resonance Imaging vs. Colour-Coded Doppler Ultrasound

Schilddrüsenperfusionsmessung als diagnostisches Verfahren beim Morbus Basedow – Arterial-Spin-Labeling-Magnetresonanztomografie vs. farbkodierte Duplex-Sonografie

K. Müssig

¹Department of Metabolic Diseases, University Hospital of Düsseldorf

²Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf

³Division of Endocrinology, Diabetes, Nephrology, Angiology, and Clinical Chemistry, Department of Internal Medicine, University Hospital of Tübingen

,

C. Schraml

⁴Department of Radiology, Section on Experimental Radiology, University Hospital of Tübingen

⁵Department of Radiology, Diagnostic and Interventional Radiology, University Hospital of Tübingen

,

R. Rietig

³Division of Endocrinology, Diabetes, Nephrology, Angiology, and Clinical Chemistry, Department of Internal Medicine, University Hospital of Tübingen

,

P. Martirosian

⁴Department of Radiology, Section on Experimental Radiology, University Hospital of Tübingen

,

N. F. Schwenzer

⁴Department of Radiology, Section on Experimental Radiology, University Hospital of Tübingen

⁵Department of Radiology, Diagnostic and Interventional Radiology, University Hospital of Tübingen

,

C. D. Claussen

⁵Department of Radiology, Diagnostic and Interventional Radiology, University Hospital of Tübingen

,

H.-U. Häring

³Division of Endocrinology, Diabetes, Nephrology, Angiology, and Clinical Chemistry, Department of Internal Medicine, University Hospital of Tübingen

,

F. Schick

⁴Department of Radiology, Section on Experimental Radiology, University Hospital of Tübingen

,

B. Balletshofer

³Division of Endocrinology, Diabetes, Nephrology, Angiology, and Clinical Chemistry, Department of Internal Medicine, University Hospital of Tübingen

› Author Affiliations

Abstract

Purpose: Though increased thyroid perfusion assessed by colour-coded Doppler ultrasound (CDUS) is characteristic of Graves’ disease (GD), sometimes perfusion assessment by CDUS is not possible. In these cases, arterial spin labelling (ASL), a novel magnetic resonance imaging (MRI) technique allowing non-invasive thyroid perfusion quantification, may have additional diagnostic value. We aimed to evaluate the potential of ASL-MRI for assessment of increased blood perfusion in patients with GD compared to CDUS.

Materials and Methods: Thyroid perfusion was measured by CDUS (volume flow rate calculated from pulsed wave Doppler signals and vessel diameter) and ASL-MRI at 1.5 T in 7 patients with GD and 10 healthy controls.

Results: In patients with GD, average perfusion in both thyroid lobes was markedly increased compared to controls. Both techniques applied for volume related perfusion as well as absolute volume flow in thyroid feeding vessels provided similar results (all p = 0.0008). Using a cut-off value of 22 ml/min for the volume flow rate assessed by CDUS in the four feeding vessels allowed discrimination between patients with GD and controls in all cases. After adjusting thyroid perfusion for the differences in organ volume, both CDUS and ASL revealed also complete discrimination between health and disease.

Conclusion: Thyroid perfusion measurement by ASL-MRI reliably discriminate GD from normal thyroid glands. In patients in whom thyroid arteries cannot be depicted by CDUS for technical or anatomical reasons, ASL-MRI may have additional diagnostic value.

Zusammenfassung

Ziel: Obwohl eine gesteigerte Schilddrüsenperfusion mittels farbkodierter Duplex-Sonografie (CDUS) charakteristisch für Morbus Basedow (GD) ist, ist die Perfusionsmessung mittels CDUS manchmal nicht möglich. In diesen Fällen hat möglicherweise Arterial Spin Labeling (ASL), eine neue Magnetresonanztomografie(MRI)-Technik, die eine nicht invasive Quantifizierung der Schilddrüsenperfusion erlaubt, einen zusätzlichen diagnostischen Wert. Wir beabsichtigten das Potenzial der ASL-MRI für die Bestimmung einer gesteigerten Perfusion bei Patienten mit GD im Vergleich mit CDUS zu untersuchen.

Material und Methoden: Bei 7 Patienten mit GD und 10 gesunden Kontrollen wurde die Schilddrüsenperfusion gemessen mittels CDUS (Volumenflussrate, errechnet aus dem Pulsed-Wave(PW)-Doppler-Signal und dem Gefäßdurchmesser) und ASL-MRI bei 1,5 T.

Ergebnisse: Bei den Patienten mit GD war die durchschnittliche Perfusion in beiden Schilddrüsenlappen im Vergleich mit den Kontrollen deutlich gesteigert. Beide Methoden angewendet für eine volumenbezogene Perfusion ebenso wie der absolute Volumenfluss in den versorgenden Gefäßen ergaben ähnliche Ergebnisse (p = 0,0008). Die Verwendung eines Grenzwerts von 22 ml/min für die Volumenflussmessung mittels CDUS erlaubte die Differenzierung zwischen Patienten mit GD und Kontrollen in allen Fällen. Nach Adjustierung der Schilddrüsenperfusionsergebnisse für die Unterschiede in den Organvolumina ergaben sowohl CDUS als auch ASL ebenfalls eine vollständige Diskriminierung zwischen gesunder und erkrankter Schilddrüse.

Schlussfolgerung: Die Schilddrüsenperfusionsmessung mittels ASL-MRI unterscheidet verlässlich zwischen GD und normalen Schilddrüsen. Bei Patienten, in denen die Schilddrüsenarterien mittels CDUS aus technischen oder anatomischen Gründen nicht dargestellt werden können, hat ASL-MRI möglicherweise einen zusätzlichen diagnostischen Wert.

Key words

thyroid - ultrasound-color doppler - MR-diffusion/perfusion - endocrine disorders

Full Text

References

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