{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T14:59:50Z","timestamp":1782572390774,"version":"3.54.5"},"reference-count":77,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T00:00:00Z","timestamp":1755475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Thyroid nodules are highly prevalent, affecting up to 75% of the population, yet most are benign. The limited specificity of ultrasound-based workup leads to substantial overdiagnosis and overtreatment, underscoring the need for improved imaging-based classification. Diffusion-weighted MRI (DWI), quantified via the apparent diffusion coefficient (ADC), has emerged as a promising imaging biomarker. This meta-analysis updates pooled diagnostic performance metrics and systematically evaluates which DWI acquisition techniques, imaging parameters, and combinations with other MRI modalities are most promising for clinical translation. Methods: PubMed, Web of Science, Scopus, and ProQuest were systematically searched. Pooled sensitivity, specificity, and area under the curve (AUC) were calculated using bivariate random-effects models. The effects of b-value, magnetic field strength, echo time, and diffusion model on diagnostic accuracy and ADC values were examined through subgroup and meta-regression analyses. Results: Forty-six studies (3003 nodules) were included. Pooled sensitivity and specificity were 0.84 (95% CI: 0.81\u20130.86) and 0.88 (95% CI: 0.85\u20130.90), with an AUC of 0.912. Intravoxel incoherent motion and diffusion kurtosis imaging showed no added value over the mono-exponential model. For the mono-exponential model, a negative association between b-values and reported ADCs was observed, whereas no association was found between b-values and diagnostic accuracy. Magnetic field strength and echo time did not affect ADCs. Combining DWI with morphological imaging showed the potential to further enhance diagnostic performance. Conclusions: DWI holds strong potential to improve the diagnostic workup of thyroid nodules. Technical standardization, particularly of key acquisition parameters, should be pursued to enable clinical implementation.<\/jats:p>","DOI":"10.3390\/cancers17162677","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T11:31:37Z","timestamp":1755516697000},"page":"2677","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnostic Accuracy of Diffusion-Weighted MRI for Differentiating Benign and Malignant Thyroid Nodules: Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1185-3709","authenticated-orcid":false,"given":"Benjamin","family":"Noto","sequence":"first","affiliation":[{"name":"Clinic for Radiology, University of M\u00fcnster and University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"},{"name":"Department of Nuclear Medicine, University of M\u00fcnster and University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolin","family":"Bobe","sequence":"additional","affiliation":[{"name":"Clinic for Radiology, University of M\u00fcnster and University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6130-5906","authenticated-orcid":false,"given":"Jonas","family":"Brandt","sequence":"additional","affiliation":[{"name":"Clinic for Radiology, University of M\u00fcnster and University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0774-5617","authenticated-orcid":false,"given":"Heiner N.","family":"Raum","sequence":"additional","affiliation":[{"name":"Clinic for Radiology, University of M\u00fcnster and University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabila Gala","family":"Nacul","sequence":"additional","affiliation":[{"name":"Clinic for Radiology, University of M\u00fcnster and University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burkhard","family":"Riemann","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University of M\u00fcnster and University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Helfen","sequence":"additional","affiliation":[{"name":"Clinic for Radiology, University of M\u00fcnster and University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,18]]},"reference":[{"key":"ref_1","first-page":"97","article-title":"The incidental thyroid nodule","volume":"68","author":"Fisher","year":"2018","journal-title":"CA A Cancer J. 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