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• Clinical Article •
Value of diffusion kurtosis imaging combined with conventional MRI in the differential diagnosis of benign and malignant thyroid nodules
TANG Qiying  LIU Xinyou  JIANG Qiuli  ZHU Liuhong  ZHOU Jianjun 

Cite this article as: TANG Q Y, LIU X Y, JIANG Q L, et al. Value of diffusion kurtosis imaging combined with conventional MRI in the differential diagnosis of benign and malignant thyroid nodules[J]. Chin J Magn Reson Imaging, 2025, 16(5): 136-142. DOI:10.12015/issn.1674-8034.2025.05.021.


[Abstract] Objective To assess the diagnostic value of unenhanced MRI with diffusion kurtosis imaging (DKI) in differential diagnosis between thyroid benign and malignant nodules.Materials and Methods A total of 96 consecutive patients, each with a single thyroid nodule, were included in this study. Among these, 39 nodules were histopathologically confirmed as benign, while 57 were malignant. All patients underwent thyroid MRI, which included T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and DKI. Two radiologists independently evaluated the images, measuring the signal intensity ratio (SIR) on T1WI and T2WI, the apparent diffusion coefficient (ADC) from DWI, as well as mean diffusivity (MD) and mean kurtosis (MK) from DKI. Additionally, morphological features of the nodules were assessed. Univariate and multivariate logistic regression analyses were performed to determine the predictive value of these imaging parameters and morphological features for malignancy. To assess the robustness of the logistic regression model, a 5-fold cross-validation approach was applied. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic effectiveness of the continuous variables that were statistically significant in the multivariate analysis.Results The characteristics of thyroid malignant nodules including lower ADC values (P < 0.001), lower MD values (P < 0.001), higher MK values (P < 0.001), younger age (P < 0.001), smaller tumor size (P < 0.001), solid component (P < 0.001), and irregular margins (P < 0.001). Multivariate analysis further revealed that lower MD values (odds ratio = 5.046; P = 0.001), smaller tumor size (odds ratio = 3.817; P = 0.001), and irregular margins (odds ratio = 84.876; P < 0.001) were independent risk factors for thyroid malignant nodules. The combined model yielded an average area under the ROC curve of 0.968 in 5-fold cross-validation, with a sensitivity of 91.4%, specificity of 84.6%, accuracy of 88.7%, and an F1 score of 0.904 at the optimal cutoff value of 0.42.Conclusions MD values derived from DKI, combined with morphological features can provide imaging diagnostic basis for the preoperative differential diagnosis between thyroid benign and malignant nodules.
[Keywords] thyroid neoplasms；thyroid carcinoma；magnetic resonance imaging；diffusion kurtosis imaging；differential diagnosis

TANG Qiying1, 2   LIU Xinyou3   JIANG Qiuli4   ZHU Liuhong1, 2   ZHOU Jianjun1, 2*  

1 Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen 361015, China

2 Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen 361015, China

3 Department of General Surgery, Zhongshan Hospital (Xiamen), Fudan University, Xiamen 361015, China

4 Department of Pathology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen 361015, China

Corresponding author: ZHOU J J, E-mail: zhoujianjunzs@126.com

Conflicts of interest   None.

Received  2025-02-23
Accepted  2025-05-09
DOI: 10.12015/issn.1674-8034.2025.05.021
Cite this article as: TANG Q Y, LIU X Y, JIANG Q L, et al. Value of diffusion kurtosis imaging combined with conventional MRI in the differential diagnosis of benign and malignant thyroid nodules[J]. Chin J Magn Reson Imaging, 2025, 16(5): 136-142. DOI:10.12015/issn.1674-8034.2025.05.021.

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