Tiroid ve Paratiroid Bezinde Görüntüleme
Özet
Tiroid bezi, trakeanın her iki yanında yer alan, sonografik olarak homojen ve izoekoik yapıya sahip, bilgisayarlı tomografide ise yüksek iyot içeriği nedeniyle hiperdens izlenen vasküler bir organdır. Bezde ektopi, aplazi ve tiroglossal kanal kistleri gibi konjenital anomalilerin yanı sıra; diffüz hiperplazi, akut, subakut, otoimmün tiroiditler ve Graves hastalığı gibi parankimal hasara, hacim ve kanlanma değişikliklerine yol açan diffüz hastalıklar görülebilmektedir. Tiroid nodülleri popülasyonun önemli bir kısmını etkilemekte olup, kolloid guatr, basit kistler ve adenomlar gibi benign lezyonlardan; papiller, folliküler, medüller ve anaplastik karsinomlar gibi malign tümörlere kadar geniş bir yelpazede incelenir. Bu nodüllerin malignite risk analizinde ve ince iğne aspirasyon biyopsisi (İİAB) endikasyonlarında, lezyonların kompozisyon, ekojenite, şekil, marjin ve odak özelliklerini puanlayan Amerikan Radyoloji Akademisi ACR TI-RADS sınıflandırma sistemi temel rehber olarak kullanılır. Normal şartlarda ultrasonografi ile ayırt edilemeyen paratiroid bezleri ise patolojik olarak büyüyüp adenom formuna ulaştığında tiroid parankiminin arkasında düzgün sınırlı, homojen, hipoekoik ovoid kitleler olarak kendini gösterir ve Doppler incelemedeki periferal rim vaskülaritesi ve polar beslenme arteri sayesinde hiler akım gösteren peritiroidal lenf nodlarından ayırt edilir.
The thyroid gland, located on both sides of the trachea, is a vascular organ that appears homogeneous and isoechoic on ultrasonography, and hyperdense on computed tomography due to its dense iodine content. In addition to congenital anomalies such as ectopia, aplasia, and thyroglossal duct cysts, the gland can be affected by diffuse diseases like diffuse hyperplasia, acute, subacute, autoimmune thyroiditis, and Graves' disease, which cause parenchymal damage, volume, and vascular changes. Thyroid nodules affect a significant portion of the population and range from benign lesions like colloid goiter, simple cysts, and adenomas to malignant tumors such as papillary, follicular, medullary, and anaplastic carcinomas. For malignancy risk assessment and fine-needle aspiration biopsy (FNAB) indications, the ACR TI-RADS classification system developed by the American College of Radiology is used as a primary guide, scoring nodules based on composition, echogenicity, shape, margin, and echogenic foci. Parathyroid glands, which are normally indistinguishable via ultrasound, present as well-circumscribed, homogeneous, hypoechoic ovoid masses behind the thyroid tissue when pathologically enlarged into adenomas; they are differentiated from lymph nodes with hilar flow via peripheral rim vascularity and a polar feeding artery on Doppler imaging.
Referanslar
Fitzpatrick TH, Siccardi MA. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Apr 14, 2021.
Toromanović A, Tahirović H. Thyroid Volume / Measurement By Ultrasound In Schoolchildren From Mildly Iodine-Deficient Area. Bosn J Basic Med Sci. 2005;5(1):18-22.
Liang, Xiao-Wen; Cai, Yong-Yi; Yu, Jin-Sui et al. Update on thyroid ultrasound, Chinese Medical Journal: August 20, 2019 - Volume 132 - Issue 16 - p 1974-1982
Hoang JK, lee WK, Lee M et al. US features of thyroid malignancy: pearls and pittfalls. Radiographics 2007;27(3):847-860; discussion 861-865.
Loevner LA. Imaging of the thyroid gland. Semin Ultrasound CT MR 1996
Hong HS, Lee EH, Jeong SH, Park J, Lee H. Ultrasonography of Various Thyroid Diseases in Children and Adolescents: A Pictorial Essay. Korean J Radiol. 2015 Mar-Apr;16(2):419-429.
Subramanyam P, Palaniswamy SS. Pictorial essay of developmental thyroid anomalies identified by Technetium thyroid scintigraphy. Indian J Nucl Med. 2015
Ahuja AT, Wong KT, King AD, Yuen EH. Imaging for thyroglossal duct cyst: the bare Essentials. Clin Radiol 2005; 60(2): 141-148
Chou J, Walters A, Hage R, et al. Thyroglossal duct cysts: anatomy, embryology and treatment. Surg Radiol Anat 2013; 35:875.
D.W. Kim, C.K. Eun, H.S. In ET AL. Sonographic Differentiation of Asymptomatic Diffuse Thyroid Disease from Normal Thyroid: A Prospective Study. American Journal of Neuroradiology November 2010, 31 (10) 1956-196
Ghaemi N, Sayedi J, Bagheri S. Acute suppurative thyroiditis with thyroid abscess: a case report and review of the literature. Iran J Otorhinolaryngol. 2014;26(74):51-55.
Cappelli C, Pirola I, Gandossi E, Formenti A, Agosti B, Castellano M. Ultrasound findings of subacute thyroiditis: a single institution retrospective review. Acta Radiologica. 2014;55(4):429-433.
Lauren Anderson, William D. Middleton ET AL. Hashimoto Thyroiditis: Part 1, Sonographic Analysis of the Nodular Form of Hashimoto Thyroiditis American Journal of Roentgenology 2010 195:1, 208-215
Barnes HV, Blizzard RM. Antithyroid drug therapy for toxic diffuse goiter (Graves disease): thirty years experience in children and adolescents. J Pediatr 1977; 91:313.
Milan Halenka, Zdeněk Fryšák. Atlas of Thyroid Ultrasonography. (2017)
Xie C, Cox P, Taylor N, LaPorte S. Ultrasonography of thyroid nodules: a pictorial review. (2016) Insights into imaging. 7 (1): 77-86.
Katz JF, et al. Thyroid nodules: Sonographicpathologic correlation. Radiology 1984;151:741,
Rho MH, Kim DW. Long-Term Ultrasonography Follow-Up of Thyroid Colloid Cysts at the Health Center: A Single-Center Study. Int J Endocrinol. 2015;2015:324581.
Li W, Song Q, Lan Y, ET AL. The Value of Sonography in Distinguishing Follicular Thyroid Carcinoma from Adenoma. Cancer Manag Res. 2021;13:3991-4002
Wong KT, Ahuja AT. Ultrasound of thyroid cancer. Cancer Imaging. 2005;5(1):157-166. Published 2005 Dec 9.
Baek HJ, Kim DW, Shin GW et al. (2018) Ultrasonographic Features of Papillary Thyroid Carcinomas According to Their Subtypes. Front. Endocrinol. 9:223.
Remonti LR, Kramer CK, Leitão CB et al. Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies. Thyroid. 2015;25(5):538-550.
Tessler FN, Middleton WD, Grant EG, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. (2017) Journal of the American College of Radiology : JACR. 14 (5): 587-595.
Kim MJ, Kim EK, Park SI et al. US-guided fine-needle aspiration of thyroid nodules: indications, techniques, results. Radiographics. 2008;28 (7): 1869-86
Baek HJ, Kim DW, Shin GW et al.(2018) Ultrasonographic Features of Papillary Thyroid Carcinomas According to Their Subtypes. Front. Endocrinol. 9:223
Sillery J, Reading C, Charboneau J, et al. Thyroid Follicular Carcinoma: Sonographic Features of 50 Cases. AJR Am J Roentgenol. 2010;194(1):44-54
Zhao, J., Zheng, X., Gao, M. et al. Ultrasound features of medullary thyroid cancer as predictors of biological behavior. Cancer Imaging 21, 33 (2021)
Sung JY. Parathyroid ultrasonography: the evolving role of the radiologist. Ultrasonography. 2015;34(4):268-274.
