Pre- and Postoperative Ultrasound and MRI Examinations in Assessing Vocal Folds in Patients with Goiter

To determine the value of dynamic examinations ultrasound (US) and MRI in the 1.5T field in the assessment of the mobility of vocal folds (VF) in comparison to laryngoscopy in patients with thyroid gland resection.

A total of 44 patients with goiter, before and after thyroidectomy, were subjected to videolaryngoscopy and dynamic examinations of the vocal folds using ultrasound and the following MRI sequences: generic gradient echo (GRE) and true fast imaging with steady-state precession (TRUFI). The qualitative and quantitative data were analyzed, i.e., the angles of deviation from the midline of the vocal folds and the area of the right and left rima glottidis compartments.

The analysis of qualitative data showed that the results obtained by laryngoscopy, US and MRI are independent of the diagnostic method used in the group of patients pre and post thyroidectomy. Between the pre- and postoperative examinations in the group of paralyzed vocal folds, statistically significant differences were found in the minimum and maximum values of the angles for the MRI-GRE and MRI-TRUFI sequences and the maximum value of the angles in the US examination, but also in the maximum value of the area of the glottis compartments in both MRI-GRE and MRI-TRUFI dynamic sequences and the minimum value of the area in the sequence MRI-GRE. Statistically significant differences were found in both MRI sequences during phonation, both for the value of the angles and the area of the affected vocal folds. However, no statistically significant differences were found in the values of the angles or the areas in both vocal fold imaging methods without identified mobility abnormalities.

Ultrasound and MRI examinations using dynamic sequences have a similar diagnostic value to laryngoscopy in the assessment of vocal fold paralysis in patients with goiter. The GRE sequence seems to be the most reliable one in determining vocal fold paralysis, and the most reliable parameter is the maximum area of the rima glottidis compartment. The inclusion of dynamic short sequences widely available in 1.5T scanners in standard neck examination protocols represents a novelty of the method and a promising diagnostic perspective in the diagnosis of vocal fold paralysis.