Caterina Giannitto, Angela Ammirabile, Giorgia Carnicelli, Ludovica Lofino, Andrea Costantino, Fabrizio Natali, Andrea Alessandro Esposito, Armando De Virgilio, Antonio Lo Casto, Giovanni Savini, Lorenzo Ugga, Giuseppe Mercante, Letterio Salvatore Politi, Steve Connor
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Diffusion-Weighted MRI (DW-MRI) has emerged as a promising, non-invasive tool, though its accuracy and the impact of acquisition parameters remain unclear.</p><p><strong>Purpose: </strong>To evaluate the diagnostic accuracy of DW-MRI in distinguishing malignant from benign thyroid nodules and identifying influencing acquisition parameters.</p><p><strong>Study type: </strong>Systematic Review and Meta-analysis (researchregistry11482).</p><p><strong>Population: </strong>2073 patients, 2403 thyroid nodules (1067 malignant).</p><p><strong>Field strength/sequence: </strong>DW-MRI at 3.0T or 1.5T.</p><p><strong>Assessment: </strong>A systematic search of Pubmed, Embase, Cochrane Library, Scopus, and Web of Science was conducted through July 2025 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy guidelines. Studies on DW-MRI in thyroid nodules were included. Risk of bias and applicability were assessed using QUADAS-2.</p><p><strong>Statistical tests: </strong>A bivariate random-effects model estimated pooled sensitivity (SE), specificity (SP), and area under the curve (AUC). Univariable and multivariable meta-regressions explored the influence of DW-MRI parameters. Subgroup analyses and pooled Apparent Diffusion Coefficient (ADC) comparisons were also performed. Results were considered statistically significant at p < 0.05.</p><p><strong>Results: </strong>Thirty-seven studies were included. DW-MRI showed pooled SE 0.84, SP 0.87, and AUC 0.91, confirmed in studies at low risk of bias (AUC 0.80). Univariable meta-regression revealed that 3.0T field strength reduced SP, while < 5 averages and acquisition matrix ≥ 130 increased SE. Nodule size ≥ 10 mm and circular region of interest improved SP. Multivariable analysis confirmed increased SE with b-values > 2 and improved SP with b ≥ 1000, while 3.0 T remained associated with reduced SP. 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引用次数: 0
摘要
背景：手术是区分甲状腺结节良恶性的金标准，但在不确定的病例中，手术是侵入性的，往往是不必要的。弥散加权MRI （DW-MRI）已成为一种很有前途的非侵入性工具，尽管其准确性和采集参数的影响尚不清楚。目的：评价DW-MRI对甲状腺结节良恶性鉴别的诊断准确性及确定影响采集参数。研究类型：系统评价和荟萃分析（researchregistry11482）。人群：2073例，甲状腺结节2403例（恶性1067例）。场强/序列：DW-MRI 3.0T或1.5T。评估：系统检索Pubmed、Embase、Cochrane Library、Scopus和Web of Science，检索截止到2025年7月，遵循诊断测试准确性系统评价和元分析指南的首选报告项目。纳入甲状腺结节的DW-MRI研究。使用QUADAS-2评估偏倚风险和适用性。统计检验：双变量随机效应模型估计合并敏感性（SE）、特异性（SP）和曲线下面积（AUC）。单变量和多变量元回归探讨了DW-MRI参数的影响。同时进行亚组分析和表观扩散系数（ADC）比较。结果认为p具有统计学意义。结果：纳入37项研究。DW-MRI显示SE为0.84，SP为0.87，AUC为0.91，在低偏倚风险（AUC为0.80）的研究中得到证实。单变量荟萃回归显示，3.0T场强降低SP， b≥1000时，2和改善SP，而3.0T仍与SP降低相关。恶性结节的ADC较低（1.08 vs. 1.73 × 10-3 mm2/s vs. 1.70 × 10-3 mm2/s），特别是b≥1000时。数据结论：DW-MRI对甲状腺结节的诊断具有良好的准确性，但受技术和方法学因素的影响。证据水平：3；技术功效：阶段3。
Impact of Diffusion-Weighted Magnetic Resonance Imaging Parameters on Diagnostic Accuracy for Thyroid Nodules: A Systematic Review and Meta-Analysis.
Background: Surgery is the gold standard to differentiate benign from malignant thyroid nodules, but it is invasive and often unnecessary in indeterminate cases. Diffusion-Weighted MRI (DW-MRI) has emerged as a promising, non-invasive tool, though its accuracy and the impact of acquisition parameters remain unclear.
Purpose: To evaluate the diagnostic accuracy of DW-MRI in distinguishing malignant from benign thyroid nodules and identifying influencing acquisition parameters.
Study type: Systematic Review and Meta-analysis (researchregistry11482).
Assessment: A systematic search of Pubmed, Embase, Cochrane Library, Scopus, and Web of Science was conducted through July 2025 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy guidelines. Studies on DW-MRI in thyroid nodules were included. Risk of bias and applicability were assessed using QUADAS-2.
Statistical tests: A bivariate random-effects model estimated pooled sensitivity (SE), specificity (SP), and area under the curve (AUC). Univariable and multivariable meta-regressions explored the influence of DW-MRI parameters. Subgroup analyses and pooled Apparent Diffusion Coefficient (ADC) comparisons were also performed. Results were considered statistically significant at p < 0.05.
Results: Thirty-seven studies were included. DW-MRI showed pooled SE 0.84, SP 0.87, and AUC 0.91, confirmed in studies at low risk of bias (AUC 0.80). Univariable meta-regression revealed that 3.0T field strength reduced SP, while < 5 averages and acquisition matrix ≥ 130 increased SE. Nodule size ≥ 10 mm and circular region of interest improved SP. Multivariable analysis confirmed increased SE with b-values > 2 and improved SP with b ≥ 1000, while 3.0 T remained associated with reduced SP. Malignant nodules showed lower ADC (1.08 vs. 1.73 × 10-3 mm2/s vs. 1.70 × 10-3 mm2/s for benign), especially with b ≥ 1000.
Data conclusion: DW-MRI shows good diagnostic accuracy for thyroid nodule assessment, although it is influenced by both technical and methodological factors.
期刊介绍：
The Journal of Magnetic Resonance Imaging (JMRI) is an international journal devoted to the timely publication of basic and clinical research, educational and review articles, and other information related to the diagnostic applications of magnetic resonance.
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