Preliminary Diagnosis: Multinodular Goiter
I. What imaging technique is first-line for this diagnosis?
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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
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Gold standard in detecting and characterizing any thyroid abnormality
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Highly sensitive and specific in detecting thyroid pathology
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Highly sensitive in detecting microcalcifications often seen in thyroid pathology
Disadvantages
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Exposes patients to ionizing radiation
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Less portable and more expensive than sonographic imaging
III. What are the contraindications for the first-line imaging technique?
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May be contraindicated in pregnant patients
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Contrast is relatively contraindicated in patients with renal failure
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Contrast is relatively contraindicated in patients with contrast allergy
IV. What alternative imaging techniques are available?
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Ultrasound of the thyroid gland
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MRI with contrast of the thyroid gland
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of multinodular goiter.
Ultrasound
Advantages
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Highly sensitive in detecting and characterizing any particular thyroid pathology
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Highly portable and a relatively inexpensive imaging modality
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Ultrasound imaging helps guide treatment
Disadvantages
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Less specific than other modalities in detecting and characterizing particular thyroid pathology
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Highly operator dependent
MRI with contrast of the thyroid gland
Advantages
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Highly sensitive and specific in detecting any primary thyroid pathology or any secondary complications
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Offers exquisite detail of the surrounding soft tissues
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Does not expose patients to ionizing radiation
Disadvantages
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Less specific in detecting thyroid calcifications compared with MR imaging
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Expensive
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Time consuming
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Requires significant patient cooperation to minimize motion artifact
VI. What are the contraindications for the alternative imaging techniques?
Ultrasound
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No specific contraindications to sonographic imaging exist.
MRI with contrast of the thyroid gland
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MR imaging is contraindicated in patients with non MR-compatible hardware.
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Gadolinium contrast is contraindicated in patients with a GFR less than or equal to 30.
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