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Borlea A, Moisa-Luca L, Popescu A, Bende F, Stoian D. Combining CEUS and ultrasound parameters in thyroid nodule and cancer diagnosis: a TIRADS-based evaluation. Front Endocrinol (Lausanne) 2024; 15:1417449. [PMID: 38952390 PMCID: PMC11215041 DOI: 10.3389/fendo.2024.1417449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 05/20/2024] [Indexed: 07/03/2024] Open
Abstract
Contrast-enhanced ultrasonography (CEUS) has been established as a diagnostic tool for assessing microvascularization, essential for understanding angiogenesis in neoplastic development. AIM This study assesses the effectiveness of CEUS as a supplementary tool to TIRADS in enhancing the ultrasound-based diagnosis of thyroid cancer. METHODS AND MATERIALS Over one year, 157 nodules in 133 patients, with predominantly solid thyroid nodules, were examined using ultrasound and CEUS and underwent thyroidectomy, allowing for a comparison of ultrasound findings with pathological reports. RESULTS Thyroid cancer was identified in 31.21% (49/157) of cases. Significant CEUS high-risk features included inhomogeneous enhancement, enhancement defects, and complete hypoenhancement (AUC 0.818, 0.767, 0.864 respectively). Nodules exhibiting any of these features were classified as high-risk in CEUS. The diagnostic performance of TIRADS improved when combined with CEUS, with AUC increasing from 0.707 to 0.840 and improved sensitivity. CONCLUSION The integration of CEUS with TIRADS significantly enhances the diagnostic accuracy and specificity in identifying thyroid cancer. This combination proves to be a more effective method for risk stratification and diagnosis, highlighting the value of CEUS as an adjunctive tool in thyroid cancer evaluation.
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Affiliation(s)
- Andreea Borlea
- Division of Endocrinology, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
| | - Luciana Moisa-Luca
- Division of Endocrinology, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
| | - Alina Popescu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Felix Bende
- Division of Gastroenterology and Hepatology, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Dana Stoian
- Division of Endocrinology, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
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Wu Y, Zhou C, Shi B, Zeng Z, Wu X, Liu J. Systematic review and meta-analysis: diagnostic value of different ultrasound for benign and malignant thyroid nodules. Gland Surg 2022; 11:1067-1077. [PMID: 35800749 PMCID: PMC9253179 DOI: 10.21037/gs-22-254] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/20/2022] [Indexed: 08/24/2023]
Abstract
BACKGROUND Conventional ultrasound and contrast-enhanced ultrasound (CEUS) are commonly used in the diagnosis of benign and malignant thyroid nodules. However, the value of the two methods in the diagnosis of benign and malignant thyroid nodules remains controversial. METHODS PubMed, Medline, EBSCO, Science Direct, Cochrane Library, China National Knowledge Infrastructure (CNKI) database and manual journal retrieval were searched from January 2000 to January 2022, to include research on conventional ultrasound or CEUS in the diagnosis of benign and malignant thyroid nodule related clinical studies. Meta-analysis was conducted using RevMan5.3 and Stata Corp to analyze the sensitivity and specificity of conventional ultrasound and CEUS in the diagnosis of benign and malignant thyroid nodules with 95% confidence interval (CI) as indicators. Heterogeneity of the results was evaluated by Q test and I2 in RevMan5.3. Deek's method was used to evaluate publication bias. RESULTS A total of 1,378 nodules were included in 11 literatures, including 535 malignant thyroid nodules and 843 benign thyroid nodules. Heterogeneity tests conducted for CEUS diagnostic sensitivity of the 6 included literatures indicated that there was no heterogeneity among the study groups [Q=2.05, degree of freedom (df) =5.00, I2=0.00%, P=0.84]. The combined sensitivity was 0.87, with 95% confidence interval (CI): 0.82 to 0.90. Heterogeneity tests on the diagnostic specificity of CEUS of the six included literatures suggested that there was heterogeneity among the different study groups (Q=14.27, df =5.00, I2=64.96%, P=0.01). The combined specificity was 0.84 (95% CI: 0.78 to 0.89). Heterogeneity tests performed on the sensitivity of five conventional ultrasound diagnosis articles revealed that there was heterogeneity among different study groups (Q=13.62, df =4.00, I2=70.64%, P=0.01). The combined sensitivity was 0.86 (95% CI: 0.78 to 0.92). Heterogeneity tests on the specificity of conventional ultrasound diagnosis in five included literatures indicated that there was heterogeneity among different study groups (Q=16.94, df =4.00, I2=76.39%, P=0.00). The combined specificity was 0.84 (95% CI: 0.75 to 0.90). There was no bias in the included literature. DISCUSSION The sensitivity of CEUS in the diagnosis of benign and malignant thyroid nodules was slightly higher than that of conventional ultrasound, which provides a reference for the clinical diagnosis of benign and malignant thyroid nodules.
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Affiliation(s)
- Yin Wu
- Department of Ultrasonic Medicine, The 2nd Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Chunmei Zhou
- Department of Ultrasonic Medicine, The 2nd Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Bo Shi
- Department of Ultrasonic Medicine, The 2nd Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Zhuohua Zeng
- Department of Ultrasonic Medicine, The 2nd Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Xinyu Wu
- Obstetrics and Gynecology Department, The 2nd Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Jiakai Liu
- Department of Ultrasonic Medicine, The 2nd Affiliated Hospital of Chengdu Medical College, Chengdu, China
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Contrast-Enhanced Ultrasonography for Differential Diagnosis of Benign and Malignant Thyroid Lesions: Single-Institutional Prospective Study of Qualitative and Quantitative CEUS Characteristics. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8229445. [PMID: 35542754 PMCID: PMC9056255 DOI: 10.1155/2022/8229445] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 03/02/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022]
Abstract
Objectives To extend and revise the diagnostic value of contrast-enhanced ultrasonography (CEUS) for differentiation between malignant and benign thyroid nodules. Methods This single-institution prospective study aims to compare CEUS qualitative and objective quantitative parameters in benign and malignant thyroid nodules. Consecutive cohort of 100 patients was examined by CEUS, 68 out of them were further analysed in detail. All included patients underwent cytological and/or histopathological verification of the diagnosis. Results Fifty-five (81%) thyroid nodules were benign, and 13 (19%) were malignant. Ring enhancement pattern was strongly associated with a benign aetiology (positive predictive value 100%) and heterogeneous enhancement pattern with malignant aetiology (positive predictive value 72.7%). The shape of the TIC (time-intensity curve) was more often identical in the benign lesion (98.2%) than in malignant lesions (69.2%), p=0.004. Conclusions This study indicates that CEUS enhancement patterns were significantly different in benign and malignant lesions. Ring enhancement was a very strong indicator of benign lesions, whereas heterogeneous enhancement was valuable to detect malignant lesions.
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Moschos E, Mentzel HJ. Ultrasound findings of the thyroid gland in children and adolescents. J Ultrasound 2022; 26:211-221. [PMID: 35138597 PMCID: PMC10063727 DOI: 10.1007/s40477-022-00660-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/14/2022] [Indexed: 10/19/2022] Open
Abstract
Ultrasonography (US) is an important diagnostic tool in evaluating thyroid diseases in pediatric patients. This pictorial essay reviews the application of various ultrasound techniques such as B-Mode ultrasound and color Doppler, elastography and contrast enhanced ultrasound (CEUS) in children and adolescents in various thyroid pathologies including congenital thyroid abnormalities, diffuse thyroid diseases (DTD), focal thyroid lesions and thyroid malignancy.
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Affiliation(s)
- Elena Moschos
- Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Hans-Joachim Mentzel
- Section of Paediatric Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
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Piskunowicz M, Back SJ, Darge K, Humphries PD, Jüngert J, Ključevšek D, Lorenz N, Mentzel HJ, Squires JH, Huang DY. Contrast-enhanced ultrasound of the small organs in children. Pediatr Radiol 2021; 51:2324-2339. [PMID: 33830288 PMCID: PMC8566395 DOI: 10.1007/s00247-021-05006-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/17/2020] [Accepted: 02/08/2021] [Indexed: 11/28/2022]
Abstract
In pediatric and adult populations, intravenous contrast-enhanced ultrasound (CEUS) remains off-label for imaging of organs other than the liver and heart. This limited scope inhibits potential benefits of the new modality from a more widespread utilization. Yet, CEUS is potentially useful for imaging small organs such as the thyroid gland, lymph nodes, testes, ovaries and uterus, with all having locations and vasculature favorable for this type of examination. In the adult population, the utility of CEUS has been demonstrated in a growing number of studies for the evaluation of these small organs. The aim of this article is to present a review of pediatric CEUS of the thyroid gland, lymph nodes, testes, ovaries and uterus as well as to draw from the adult literature indications for possible applications in children.
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Affiliation(s)
- Maciej Piskunowicz
- Department of Radiology, Medical University of Gdansk, M. Sklodowskiej-Curie 3a Street, 80-210, Gdansk, Poland.
| | - Susan J. Back
- grid.25879.310000 0004 1936 8972Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Kassa Darge
- grid.25879.310000 0004 1936 8972Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Paul D. Humphries
- grid.424537.30000 0004 5902 9895Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Jörg Jüngert
- grid.5330.50000 0001 2107 3311Department of Pediatrics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Damjana Ključevšek
- grid.29524.380000 0004 0571 7705Department of Radiology, University Children’s Hospital Ljubljana, Ljubljana, Slovenia
| | - Norbert Lorenz
- grid.4488.00000 0001 2111 7257Children’s Hospital, Dresden Municipal Hospital, Teaching-Hospital of Technical University Dresden, Dresden, Germany
| | - Hans-Joachim Mentzel
- grid.275559.90000 0000 8517 6224Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital, Jena, Germany
| | - Judy H. Squires
- grid.239553.b0000 0000 9753 0008Department of Radiology, University of Pittsburgh Medical Center, Children’s Hospital of Pittsburgh, Pittsburgh, PA USA
| | - Dean Y. Huang
- grid.46699.340000 0004 0391 9020Department of Radiology, King’s College Hospital, Denmark Hill, London, UK
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Zhang J, Zhang X, Meng Y, Chen Y. Contrast-enhanced ultrasound for the differential diagnosis of thyroid nodules: An updated meta-analysis with comprehensive heterogeneity analysis. PLoS One 2020; 15:e0231775. [PMID: 32310968 PMCID: PMC7170259 DOI: 10.1371/journal.pone.0231775] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/31/2020] [Indexed: 12/16/2022] Open
Abstract
The diagnostic accuracy of contrast-enhanced ultrasound (CEUS) for distinguishing malignant thyroid nodules from benign thyroid nodules remains controversial. This meta-analysis was performed to evaluate the overall diagnostic value of CEUS for the characterization of thyroid nodules. Relevant studies were identified by searching PubMed, Embase and the Cochrane Library until August 1th 2019 to assess the overall diagnostic accuracy of CEUS. 37 eligible studies were included in the present meta-analysis. The pooled sensitivity, specificity, positive likelihood rate, negative likelihood rate and diagnostic odds ratio of CEUS were 0.87, 0.83, 5.38, 0.17 and 38.94, respectively, with the AUC of 0.9263. Subgroup analysis showed the heterogeneity was greatly reduced in small nodules group (≤ 1 cm) (I2 = 0.0%), while heterogeneity was still observed in the group of variable sizes group (I2 = 69.5%). However, meta-regression analysis revealed that only diagnostic criterion was the major source of heterogeneity (p = 0.0259). The risk of publication bias was negligible (p = 0.35). CEUS exhibited high accuracy for the identification of thyroid nodules and might provide additional perfusion information for the current US imaging reporting systems.
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Affiliation(s)
- Juanjuan Zhang
- Department of Ultrasound, Huaihe Hospital of Henan University, Henan, China
| | - Xiuting Zhang
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanna Meng
- Department of Ultrasound, Huaihe Hospital of Henan University, Henan, China
| | - Yinghong Chen
- Department of Ultrasound, Huaihe Hospital of Henan University, Henan, China
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Zhao H, Liu X, Lei B, Cheng P, Li J, Wu Y, Ma Z. Impact of thyroid nodule sizes on the diagnostic performance of Korean thyroid imaging reporting and data system and contrast-enhanced ultrasound. Clin Hemorheol Microcirc 2019; 72:317-326. [PMID: 30856106 DOI: 10.3233/ch-180545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Huaqun Zhao
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Xueling Liu
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Bei Lei
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Ping Cheng
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Jian Li
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Yedong Wu
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Zhen Ma
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
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The Association Among Quantitative Contrast-Enhanced Ultrasonography Features, Thyroid Imaging Reporting and Data System and BRAF V600E Mutation Status in Patients With Papillary Thyroid Microcarcinoma. Ultrasound Q 2019; 35:228-232. [DOI: 10.1097/ruq.0000000000000406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Liu Q, Cheng J, Li J, Gao X, Li H. The diagnostic accuracy of contrast-enhanced ultrasound for the differentiation of benign and malignant thyroid nodules: A PRISMA compliant meta-analysis. Medicine (Baltimore) 2018; 97:e13325. [PMID: 30544392 PMCID: PMC6310493 DOI: 10.1097/md.0000000000013325] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) is a non-invasive method that has been used in the diagnosis of several diseases. Recently, CEUS has been used in the differentiation of benign and malignant thyroid nodules. However, the performance of CEUS in thyroid nodules has not been studied clearly. METHODS The databases of Pubmed, Embase, Cochrane library and the unpublished studies were systematically searched for candidate inclusions, with the use of CEUS in differentiating the benign and malignant thyroid nodules. The quality of included studies was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS) questionnaire. The pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), positive and negative likelihood ratio (NLR) were calculated using STATA software version 14.0. RESULTS Totally 33 diagnostic studies were included for further analysis. The quality of included studies was relatively high using QUADAS method. The pooled estimates of sensitivity and specificity were 0.88 (95% CI 0.85, 0.91) and 0.88 (95% CI 0.83, 0.91), respectively. In addition, the DOR, the positive and NLRs were pooled positive LR and the negative LR were 54 (95% CI 33, 89), 7.1% (5.2%, 9.8%), and 0.13% (0.10%, 0.18%). No significant publication bias was observed. CONCLUSIONS Our meta-analysis further indicated that CEUS is a useful tool in differentiating benign and malignant thyroid nodules, with high sensitivity and specificity.
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Affiliation(s)
| | | | | | | | - Hongbo Li
- Department of General Surgery, People's Hospital of Rizhao, Rizhao, China
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Zhan J, Ding H. Application of contrast-enhanced ultrasound for evaluation of thyroid nodules. Ultrasonography 2018; 37:288-297. [PMID: 30213158 PMCID: PMC6177690 DOI: 10.14366/usg.18019] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/03/2018] [Indexed: 12/14/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) is widely used to evaluate tumor microcirculation, which is useful in the differential diagnosis between benignity and malignancy. In the last 10 years, the applicability of CEUS to thyroid nodules has greatly improved due to technological refinements and the development of second-generation contrast agents. In this review, we summarize the applications of CEUS for thyroid nodules, focusing on the imaging findings of malignant and benign nodules in the existing literature and the use of those findings to predict malignancies, with an additional brief description of the utilization of CEUS for other thyroid-related diseases.
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Affiliation(s)
- Jia Zhan
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Hong Ding
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Wang Y, Nie F, Liu T, Yang D, Li Q, Li J, Song A. Revised Value of Contrast-Enhanced Ultrasound for Solid Hypo-Echoic Thyroid Nodules Graded with the Thyroid Imaging Reporting and Data System. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:930-940. [PMID: 29472113 DOI: 10.1016/j.ultrasmedbio.2017.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 10/26/2017] [Accepted: 12/21/2017] [Indexed: 06/08/2023]
Abstract
The use of ultrasound in differentiation of benign and malignant solid hypo-echoic thyroid nodules is a dilemma in clinical practice. The aim of this study was to investigate the revised value of contrast-enhanced ultrasound (CEUS) for differentiating solid hypo-echoic thyroid nodules using the Thyroid Imaging Reporting and Data System (TI-RADS).The study included 135 patients with 135 nodules confirmed by fine-needle aspiration and/or surgery. Every nodule underwent both conventional US and CEUS. Binary logistic regression analysis for conventional US features revealed that irregular shape, microcalcification and height greater than width were significant malignant predictive features. Binary logistic analysis for CEUS features indicated that hetero-enhancement, slow wash-in, an ill-defined enhancement border and fast wash-out were significantly associated with malignancy. The areas under the curve of the TI-RADS, CEUS and the combination were 0.806, 0.934 and 0.950, respectively. CEUS is a potentially useful tool in the differentiation of solid hypo-echoic thyroid nodules.
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Affiliation(s)
- YanFang Wang
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Fang Nie
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China.
| | - Ting Liu
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Dan Yang
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Qi Li
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Jing Li
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - AiLing Song
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China
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Ebeed AE, Romeih MAEH, Refat MM, Salah NM. Role of ultrasound, color doppler, elastography and micropure imaging in differentiation between benign and malignant thyroid nodules. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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