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Tracheal Invasion by Thyroid Carcinoma

Prediction Using MR Imaging

¹ Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
² Department of Surgery, Shinshu University School of Medicine, Matsumoto 390-8621, Japan.

View larger version (124K): [in a new window]   Fig. 1A. —55-year-old male cadaver. Axial unenhanced T1-weighted MR image (TR/TE, 500/16; excitations, 2) shows horseshoe-shaped healthy trachea. Mucous membrane of trachea (thick arrows) has intermediate signal intensity, posterior membranous portion (curved arrow) has intermediate signal intensity with inwardly concave shape, and tracheal cartilage (arrowheads) has intermediate signal intensity mixed with low signal intensity. Signal intensity of mucous membrane slightly exceeds that of tracheal cartilage and that of posterior membranous portion.

View larger version (153K): [in a new window]   Fig. 1B. —55-year-old male cadaver. Axial T2-weighted MR image (5000/81; excitations, 2) at same level as A shows mucous membrane and submucosal tissue (thick arrows) to have high signal intensity, posterior membranous portion (curved arrow) to have intermediate signal intensity, and tracheal cartilage (arrowheads) to have low signal intensity.

View larger version (150K): [in a new window]   Fig. 1C. —55-year-old male cadaver. Coronal T2-weighted MR image (5000/81; excitations, 2) shows cartilage (arrows) to have low signal intensity and intercartilaginous portions (arrowheads) to have intermediate signal intensity. T = thyroid gland.

View larger version (129K): [in a new window]   Fig. 1D. —55-year-old male cadaver. Photomicrograph of axial section of trachea shows trachea to consist of mucous membrane (epithelium [thin arrows] and submucosal tissue [S]), cartilage (C), and adventitia (open arrows). Thicknesses were approximately 1 mm for mucous membrane and cartilage and approximately 0.1-0.3 mm for adventitia. (H and E, x4)

View larger version (82K): [in a new window]   Fig. 1E. —55-year-old male cadaver. Photomicrograph of coronal section of trachea shows cartilage (C) of 2-5 mm in vertical length. Intercartilaginous areas (arrows) measure 0.5-1 mm vertically. (H and E, x1.5)

View larger version (147K): [in a new window]   Fig. 2A. —Intraluminal mass and soft tissue in tracheal cartilage on MR images in 57-year-old woman with papillary thyroid carcinoma. Unenhanced T1-weighted image (TR/TE, 700/13; excitations, 2) shows mass lesion (arrow) protruding into tracheal lumen.

View larger version (178K): [in a new window]   Fig. 2B. —Intraluminal mass and soft tissue in tracheal cartilage on MR images in 57-year-old woman with papillary thyroid carcinoma. T2-weighted image (2,000/70; excitations, 1) reveals two mass lesions (arrowheads) of slight hyperintensity in both lobes of thyroid gland. Intraluminal mass (arrows), which has MR signal similar to that of thyroid tumors, is seen. N = metastatic lymph nodes.

View larger version (167K): [in a new window]   Fig. 2C. —Intraluminal mass and soft tissue in tracheal cartilage on MR images in 57-year-old woman with papillary thyroid carcinoma. Contrast-enhanced T1-weighted image (700/13; excitations, 2) shows tumors (arrowheads) and intraluminal mass (arrows) that exhibit moderate enhancement. Mucous membrane (white arrow) is preserved and shows marked enhancement. N = metastatic lymph nodes.

View larger version (140K): [in a new window]   Fig. 2D. —Intraluminal mass and soft tissue in tracheal cartilage on MR images in 57-year-old woman with papillary thyroid carcinoma. Photomicrograph of surgically resected specimen shows tumor extension to submucosal areas (arrowheads) through intercartilaginous portion (arrow). Epithelium of mucous membrane (open arrows) and tracheal cartilage (C) are preserved. TL = tracheal lumen. (H and E, x 4)

View larger version (114K): [in a new window]   Fig. 3A. —Soft-tissue signal intensity without intraluminal mass on MR images in 20-year-old woman with papillary thyroid carcinoma. Mass lesion in left lobe of thyroid gland appears isointense with normal gland on unenhanced T1-weighted image (TR/TE, 700/13; excitations, 2) (arrows). No deformity of trachea is seen.

View larger version (122K): [in a new window]   Fig. 3B. —Soft-tissue signal intensity without intraluminal mass on MR images in 20-year-old woman with papillary thyroid carcinoma. T2-weighted image (3200/91; excitations, 2) shows hyperintense mass lesion (arrows) in left lobe of thyroid gland and area of abnormal signal intensity within tracheal cartilage (white arrow).

View larger version (117K): [in a new window]   Fig. 3C. —Soft-tissue signal intensity without intraluminal mass on MR images in 20-year-old woman with papillary thyroid carcinoma. Thyroid tumor (arrows) shows pronounced enhancement on contrast-enhanced T1-weighted image (700/13; excitations, 2). Area within cartilage that appears hyperintense on T2-weighted MR images (white arrow) also shows synchronous enhancement with thyroid tumor. No intraluminal mass is seen.

View larger version (156K): [in a new window]   Fig. 3D. —Soft-tissue signal intensity without intraluminal mass on MR images in 20-year-old woman with papillary thyroid carcinoma. Photomicrograph of surgically resected specimens shows tumor invasion (arrows) in intercartilaginous portions. Mucous membrane and cartilage are preserved. T = thyroid tumor; C = tracheal cartilage; TL = tracheal lumen. (H and E, x 4)

View larger version (129K): [in a new window]   Fig. 4A. —Extensive tumor circumference around trachea is seen on MR images in 80-year-old woman with papillary thyroid carcinoma. Unenhanced T1-weighted image (TR/TE, 900/15; excitations, 1) shows hypointense thyroid tumor (arrowheads) in right lobe, isthmus, and part of left lobe of thyroid gland that encroaches greater than 180° of the tracheal circumference (black arrows). Calcification (white arrow) is seen in the tumor.

View larger version (153K): [in a new window]   Fig. 4B. —Extensive tumor circumference around trachea is seen on MR images in 80-year-old woman with papillary thyroid carcinoma. Thyroid tumor (arrowheads) appears hyperintense on T2-weighted image (2,000/70; excitations, 1). Tracheal circumference (black arrows) and calcification (white arrow) in the tumor can be seen (compare with A and C). No soft-tissue signal intensity within cartilage or intraluminal mass is seen.

View larger version (133K): [in a new window]   Fig. 4C. —Extensive tumor circumference around trachea is seen on MR images in 80-year-old woman with papillary thyroid carcinoma. Tumor (arrowheads) shows pronounced enhancement on post contrast T1-weighted images (900/15; excitations, 1). Tracheal circumference (black arrows) and calcification (white arrow) in the tumor can be seen (compare with A and B).

View larger version (152K): [in a new window]   Fig. 4D. —Extensive tumor circumference around trachea is seen on MR images in 80-year-old woman with papillary thyroid carcinoma. Photomicrograph of surgically resected specimen shows scattered foci of tumor invasion (arrows) between collagenous fibers of adventitia (arrowheads) but no deep invasion is identified. C = thyroid cartilage, asterisk = foci of tumor cells. (H and E, x 10)

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