Preliminary Diagnosis: Multinodular Goiter

I. What imaging technique is first-line for this diagnosis?

  • CT with contrast of the soft tissues of the neck and chest

II. Describe the advantages and disadvantages of this technique for diagnosis of multinodular goiter.

Advantages
  • Gold standard in detecting and characterizing any thyroid abnormality

  • Highly sensitive and specific in detecting thyroid pathology

  • Highly sensitive in detecting microcalcifications often seen in thyroid pathology

Disadvantages
  • Exposes patients to ionizing radiation

  • Less portable and more expensive than sonographic imaging

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients

  • Contrast is relatively contraindicated in patients with renal failure

  • Contrast is relatively contraindicated in patients with contrast allergy

IV. What alternative imaging techniques are available?

  • Ultrasound of the thyroid gland

  • MRI with contrast of the thyroid gland

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of multinodular goiter.

Ultrasound
Advantages
  • Highly sensitive in detecting and characterizing any particular thyroid pathology

  • Highly portable and a relatively inexpensive imaging modality

  • Ultrasound imaging helps guide treatment

Disadvantages
  • Less specific than other modalities in detecting and characterizing particular thyroid pathology

  • Highly operator dependent

MRI with contrast of the thyroid gland
Advantages
  • Highly sensitive and specific in detecting any primary thyroid pathology or any secondary complications

  • Offers exquisite detail of the surrounding soft tissues

  • Does not expose patients to ionizing radiation

Disadvantages
  • Less specific in detecting thyroid calcifications compared with MR imaging

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

VI. What are the contraindications for the alternative imaging techniques?

Ultrasound
  • No specific contraindications to sonographic imaging exist.

MRI with contrast of the thyroid gland
  • MR imaging is contraindicated in patients with non MR-compatible hardware.

  • Gadolinium contrast is contraindicated in patients with a GFR less than or equal to 30.