Radiology Reports for Incidental Thyroid Nodules on CT and MRI: High Variability across Subspecialties

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Fig 1.
Flowchart of study patients. FNA indicates fine needle aspiration.
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Fig 2.
Source of imaging studies with reported incidental thyroid nodules.
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Fig 3.
Three patients with incidental thyroid nodules that were similar in size but were reported differently. A, A 46-year-old man with a 12-mm incidental nodule in the left thyroid lobe detected on chest CTA performed to evaluate an abdominal aortic aneurysm. The nodule was reported only in the “Findings” section of the report without a recommendation. B, A 47-year-old woman with a 10-mm incidental nodule in the right thyroid lobe detected on chest CTA performed to evaluate chest pain. The nodule was reported in the “Impression” section without a recommendation. C, A 63-year-old man with several incidental thyroid nodules detected on cervical spine CT performed to evaluate neck injury. The largest was in the left thyroid lobe and measured 10 mm. The nodule was reported in the “Impression” section with a recommendation for sonography.

The Duke 3-tiered system for CT, MRI, or PET-detected thyroid nodules^{1,13,14,^a}

Category	Criteria for Categories	Recommendations
Risk category 1: highly suspicious for malignancy	PET avid thyroid nodule	Strongly consider work-up with ultrasound for any size nodule
Risk category 1: highly suspicious for malignancy	Suspicious lymphadenopathy;^{^b} extrathyroid spread with or without signs of vocal cord palsy on side of nodule; lung metastases
Risk category 2: indeterminate with risk factor of young age	Age younger than 35 years	Consider work-up with ultrasound if ≥1 cm in adults
		Consider work-up with ultrasound for any size in pediatric patients
Risk category 3: indeterminate without risk factors	Age 35 years or older	Consider work-up with ultrasound if ≥1.5 cm

↵a Intended for management of incidental thyroid nodules in low-risk patients.
↵b Suspicious lymph nodes are defined as nodes >10 mm in the short axis (with the exception of jugulodigastric lymph nodes, which are permitted to be up to 15 mm in the short axis) or nodes that contain either calcifications, cystic components, or irregular margins.