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Using MR Imaging to Predict Invasion of the Recurrent Laryngeal Nerve by Thyroid Carcinoma

Shodayu Takashima1, Fumiyoshi Takayama1, Jichen Wang1, Shinya Kobayashi2 and Masumi Kadoya1

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.



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  		Fig. 1A. —60-year-old woman with papillary thyroid carcinoma. True-positive diagnosis was made using morphologic assessment with MR imaging. Transverse T2-weighted MR image (TR/TE, 3200/91; excitations, 2) obtained at level of hypopharynx shows enlarged left piriform sinus (arrowheads).

 


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  		Fig. 1B. —60-year-old woman with papillary thyroid carcinoma. True-positive diagnosis was made using morphologic assessment with MR imaging. Transverse T2-weighted MR image (3200/91; excitations, 2) obtained at level of true vocal cord shows anteromedial deviation of arytenoid cartilage (arrow) and paramedian cord (arrowhead) on left side. Diagnosis of vocal cord paralysis was made on basis of morphologic findings.

 


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  		Fig. 1C. —60-year-old woman with papillary thyroid carcinoma. True-positive diagnosis was made using morphologic assessment with MR imaging. Unenhanced transverse T1-weighted MR image (700/13; excitations, 2) shows completely effaced fatty tissue in left tracheoesophageal groove, indicating tumor invasion of left recurrent laryngeal nerve. T = trachea, E = esophagus.

 


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  		Fig. 1D. —60-year-old woman with papillary thyroid carcinoma. True-positive diagnosis was made using morphologic assessment with MR imaging. Transverse T2-weighted MR image (3200/91; excitations, 2) shows 4.2-cm mass (arrowheads) in left lobe and isthmus of thyroid gland. Posterior tumor extension is visible. Tumor invasion to right recurrent laryngeal nerve was verified at surgery. E = esophagus.

 


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  		Fig. 2A. —81-year-old woman with anaplastic thyroid carcinoma who received false-negative diagnosis on basis of our criterion. T = trachea, E = esophagus. Unenhanced transverse T1-weighted MR image (TR/TE, 700/13; excitations, 2) shows preserved fatty tissue (arrowhead) in right tracheoesophageal groove.

 


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  		Fig. 2B. —81-year-old woman with anaplastic thyroid carcinoma who received false-negative diagnosis on basis of our criterion. T = trachea, E = esophagus. Gadolinium-enhanced transverse T1-weighted MR image (700/13; excitations, 2) shows 4.2-cm mass (arrowheads) in right lobe and isthmus of thyroid gland. Note calcification (C). Tumor invasion to right recurrent laryngeal nerve and trachea was verified at surgery.

 


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  		Fig. 3. —38-year-old woman with papillary thyroid carcinoma who received false-negative diagnosis on basis of our criterion. Unenhanced transverse T1-weighted MR image (TR/TE, 700/13; excitations, 2) obtained at level of sternal notch shows metastatic lymph nodes (N) in pretracheal and paratracheal regions. Although fatty tissue in left tracheoesophageal groove (arrowhead) is preserved, invasion of left recurrent laryngeal nerve by metastatic nodes was identified at surgery. B = brachiocephalic vein, E = esophagus, T = trachea, 1 = left common carotid artery, 2 = left subclavian artery, 3 = brachiocephalic artery.

 

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