Computed tomography of the thyroid ,88 and and9).9). CT scans are also the most sensitive diagnostic tool for the detection of pulmonary micro-metastases. Many of the neck US features that are considered as suggestive signs of disease recurrence are also applicable to CT examination. These signs might include sizable rounded nodules in the thyroid bed, fine calcifications, or cystic change. In cases of elevated thyroglobulin with negative neck US and iodine whole body scintigraphy (WBS), fluorodeoxyglucose (FDG) positron emission tomography (PET) is the next modality of choice. Dedifferentiated thyroid carcinoma usually has avid FDG-PET uptake and a negative radioiodine scan, typically does not respond to
Computed tomography of the thyroid iodine (RAI) ablation is an option, especially in patients with distant metastasis, tumours larger than 4 cm, or extra-thyroidal disease extension. Ultrasound examination is usually adequate in evaluating primary tumours and cervical lymph nodes. Preoperative cross-sectional imaging with CT or MRI is indicated if there is a concern for local invasion that may alter the patient’s staging as well as surgical approach (Figs. 4, ,55 and 6)6) . Some thyroid primaries may be small, diffuse, or multifocal and therefore may be occult on imaging (Fig. 4) . In patients with known thyroid malignancies, a non-enhanced exam is preferred due to