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Negroni D, Maddalena G, Bono R, Abruzzese F, Cesano S, Conte P, Airoldi C, Carriero A. Superb microvascular imaging (SMI) and elastosonography in thyroid nodule: diagnostic value in a real-time cohort. J Ultrasound 2024; 27:613-620. [PMID: 38967880 PMCID: PMC11333404 DOI: 10.1007/s40477-024-00898-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/20/2024] [Indexed: 07/06/2024] Open
Abstract
PURPOSE In clinical practice, thyroid nodules are classified according to TI-RADS by B-mode and color-flow Doppler study. The aim of the study is to evaluate the possible added value of Superb microvascular imaging (SMI) and elastosonography in the stratification of malignancy risk of thyroid nodules. METHODS All patients with thyroid nodules who were candidates for needle aspiration were enrolled. Experienced operators performed a standard examination with TI-RADS calculation, followed by SMI and elastosonography on the nodules. The needle aspiration outcome was used as the gold standard. Statistical analysis calculated the ROC curves of the techniques applied individually and serially. RESULTS In this prospective study, we analysed 260 nodules, found in 251 patients (mean age 58.6 yo ± 14). 11.2% were TI-RADS 1, 18.9% TI-RADS 2, 41.1% TI-RADS 3, 28.1% TI-RADS 4, and 0.8% TI-RADS 5. The SMI technique showed an AUC of 0.57 (95% CI 0.49; 0.66) while elastosonography had an AUC of 0.58 (95% CI 0.49; 0.67) when used individually. SMI together with elastosonography had AUC of 0.62 (95% CI 0.52; 0.71). TI-RADS had AUC of 0.67 (95% CI 0.59; 0.75). SMI and elastosonography applied together with TI-RADS had AUC of 0.69 (95% CI 0.61; 0.77). CONCLUSION In the real-world cohort of patients, the SMI technique and elastosonography slightly increase the AUC of TI-RADS. Taken individually, SMI and elastosonography do not have a very strong AUC.
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Affiliation(s)
- Davide Negroni
- Department of Radiology, "Maggiore della Carità" Hospital, Novara, Piedmont, Italy.
| | - Gaetano Maddalena
- Department of Radiology, "Maggiore della Carità" Hospital, Novara, Piedmont, Italy
| | - Romina Bono
- Department of Radiology, "Maggiore della Carità" Hospital, Novara, Piedmont, Italy
| | - Flavia Abruzzese
- Department of Radiology, "Maggiore della Carità" Hospital, Novara, Piedmont, Italy
| | - Sara Cesano
- Department of Radiology, "Maggiore della Carità" Hospital, Novara, Piedmont, Italy
| | - Patrizio Conte
- Department of Radiology, "Maggiore della Carità" Hospital, Novara, Piedmont, Italy
| | - Chiara Airoldi
- Department of Translation Medicine, University of "Piemonte Orientale", Novara, Piedmont, Italy
| | - Alessandro Carriero
- Department of Radiology, "Maggiore della Carità" Hospital, Novara, Piedmont, Italy
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Bojunga J, Trimboli P. Thyroid ultrasound and its ancillary techniques. Rev Endocr Metab Disord 2024; 25:161-173. [PMID: 37946091 DOI: 10.1007/s11154-023-09841-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/12/2023]
Abstract
Ultrasound (US) of the thyroid has been used as a diagnostic tool since the late 1960s. US is the most important imaging tool for diagnosing thyroid disease. In the majority of cases a correct diagnosis can already be made in synopsis of the sonographic together with clinical findings and basal thyroid hormone parameters. However, the characterization of thyroid nodules by US remains challenging. The introduction of Thyroid Imaging Reporting and Data Systems (TIRADSs) has improved diagnostic accuracy of thyroid cancer significantly. Newer techniques such as elastography, superb microvascular imaging (SMI), contrast enhanced ultrasound (CEUS) and multiparametric ultrasound (MPUS) expand diagnostic options and tools further. In addition, the use of artificial intelligence (AI) is a promising tool to improve and simplify diagnostics of thyroid nodules and there is evidence that AI can exceed the performance of humans. Combining different US techniques with the introduction of new software, the use of AI, FNB as well as molecular markers might pave the way for a completely new area of diagnostic accuracy in thyroid disease. Finally, interventional ultrasound using US-guided thermal ablation (TA) procedures are increasingly proposed as therapy options for benign as well as malignant thyroid diseases.
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Affiliation(s)
- Joerg Bojunga
- Department of Medicine I, Goethe University Hospital, Theodor-Stern-Kai 7, Frankfurt am Main, 60590, Germany.
| | - Pierpaolo Trimboli
- Servizio di Endocrinologia e Diabetologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, Switzerland
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Petersen M, Klemenz B, Schenke SA. [Elastography in thyroid nodules]. Laryngorhinootologie 2023; 102:839-849. [PMID: 37918385 DOI: 10.1055/a-2144-4176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Elastography is an imaging method to examine the elasticity of tissue. In the meantime, various elastography methods have been developed, which are subdivided according to the type of stimulus applied. In principle, a distinction should be made between strain elastography (SE) and shear wave elastography (SWE). Both methods provide another means of assessing thyroid disease in addition to conventional B-mode sonography. OBJECTIVE The aim is to provide an overview of elastography techniques including physical basics and their importance in the clarification algorithm of thyroid nodules. MATERIALS AND METHODS International guidelines and recent publications on elastography were selectively assessed. RESULTS Elastography provides additional information compared to conventional B-mode sonography. The change in shear stiffness is the essential physical mechanism for tissue contrast in all elastograms. In addition to the qualitative assessment of elasticity in SE, quantification is possible with SWE. In the international literature, elastography was analyzed as a single method or in comparison or combination with conventional B-mode sonography and especially with standardization using a risk stratification system (RSS, TIRADS). The results are quite controversial. In nodules with unclear findings on fine-needle biopsy (Bethesda III/IV), the combination of morphologic criteria and elastography improved diagnostic accuracy. In particular, the high negative predictive value of soft nodules represents a relevant added value. This strength of the method can play an important role in the clarification of nodules with intermediate malignancy risk or of unclear FNB results. Elastography has previously only been incorporated into French-TIRADS. Although the procedure is mentioned in the EU-TIRADS as a complementary method, integration has not been described. Limitations of the method are idealized basic assumptions, dependence of manufacturer and examiner, and artifacts. CONCLUSION Elastography can be a useful adjunct to standard diagnostic procedures in the evaluation of thyroid nodules, especially in nodules with intermediate risk of malignancy and unclear results on fine needle aspiration.
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Affiliation(s)
- Manuela Petersen
- Arbeitsbereich Gefäßchirurgie, Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Germany
| | - Burkhard Klemenz
- Klinik für Nuklearmedizin, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Simone A Schenke
- Klinik und Institut für Nuklearmedizin, Klinikum Bayreuth GmbH, Bayreuth, Germany
- Bereich Nuklearmedizin, Universitätsklinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg
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Rajabzadeh F, Hassannejad E, Akhlaghipour I, Imen MJ, Babazadeh Baghan A, Goshayeshi L, Taghavi SM, Vojouhi S, Payandeh A, Moodi Ghalibaf A. Differentiating benign and malignant thyroid nodules: A cross-sectional study on the comparison of diagnostic value of ultrasound elastography and fine needle aspiration biopsy. Health Sci Rep 2023; 6:e1619. [PMID: 37822842 PMCID: PMC10563170 DOI: 10.1002/hsr2.1619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
Background and Aim This study examines the comparison of ultrasound elastography and fine needle aspiration (FNA) in diagnosing thyroid cancers and investigates the use of elastography as the initial diagnostic test of thyroid cancers to avoid the need for invasive diagnostic tests. Methods In this study, 28 patients with 48 thyroid nodules (TNs) who were candidates for FNA or surgery were examined within a period of 18 months. Cut-off and subsequently sensitivity and specificity for elastography results, compared to pathology results as the gold standard, were calculated using the receiver operating characteristic curve (ROC). Results Based on ROC, the cut-off point differentiating the tissue stiffness between benign and malignant TNs was 25.400 kilopascal (kPa) (sensitivity of 90.9% and specificity of 78.4%). It was observed that age affects the tissue stiffness; therefore, the cut-off was defined as 65.625 kpa for age groups under 50 years old (sensitivity of 100% and specificity of 100%) and 25.400 kpa for the age group above 50 years old (sensitivity of 88.9% and specificity of 70.4%). Conclusion Based on the high sensitivity and specificity of shear wave elastography in the differentiation of benign and malignant TNs, it can be employed as a stand-alone or in combination with other diagnostic techniques to reduce the need for inessential surgical operations. However, future studies or developments are needed on this promising diagnostic technique.
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Affiliation(s)
- Farnood Rajabzadeh
- Department of Radiology, Faculty of Medicine, Mashhad Medical SciencesIslamic Azad UniversityMashhadIran
| | - Ehsan Hassannejad
- Department of Radiology, School of MedicineBirjand University of Medical SciencesBirjandIran
| | - Iman Akhlaghipour
- Student Research Committee, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | | | - Atefeh Babazadeh Baghan
- Student Research Committee, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Ladan Goshayeshi
- Department of Gastroentrology and Hepatology, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
- Surgical Oncology Research Center, Imam Reza Hospital, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | | | - Shohreh Vojouhi
- Endocrine Research Center, School of MedicineMashhad University of Medical SciencesMashhadIran
| | - Asma Payandeh
- Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - AmirAli Moodi Ghalibaf
- Student Research Committee, Faculty of MedicineBirjand University of Medical SciencesBirjandIran
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Močnik M, Golob Jančič S, Marčun Varda N. Liver and kidney ultrasound elastography in children and young adults with hypertension or chronic kidney disease. Pediatr Nephrol 2023; 38:3379-3387. [PMID: 37154960 DOI: 10.1007/s00467-023-05984-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/06/2023] [Accepted: 04/06/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Ultrasound elastography is a research method increasingly used to measure tissue elasticity. The aim of the study was to assess its usability in pediatric patients with either chronic kidney disease (CKD) or hypertension. METHODS A total of 46 patients with CKD (group 1), 50 patients with hypertension (group 2), and 33 healthy participants as the control group were included. In all, we performed studies assessing their cardiovascular risk along with liver and kidney elastography. RESULTS Liver elastography parameters were increased compared to those in the control group (1.49 m/s, p = 0.007, in group 1 and 1.52 m/s, p < 0.001, in group 2, vs. 1.41 m/s among controls). Kidney elastography parameters were significantly higher in group 2 (1.9 m/s, p = 0.001, and 1.9 m/s, p = 0.003, in each kidney) when compared to group 1 (1.79 m/s and 1.81 m/s). Additionally, all participants were divided according to overweight/obesity and normal weight status, where both liver (1.53 m/s vs. 1.45 m/s, p < 0.001) and kidney parameters (1.96 m/s and 1.92 m/s vs. 1.81 m/s and 1.84 m/s, p = 0.002) were significantly higher in the group of overweight/obese subjects. CONCLUSIONS Ultrasound elastography of the liver and kidney is feasible in pediatric patients with either CKD or hypertension, showing increased liver stiffness parameters in both groups, further aggravated by obesity. In obese patients with CKD, kidney stiffness also increased indicating a negative effect of clustering cardiovascular risk factors leading to decreased kidney elasticity. Further research is warranted. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Mirjam Močnik
- Department of Pediatrics, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000, Maribor, Slovenia.
| | - Sonja Golob Jančič
- Department of Pediatrics, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000, Maribor, Slovenia
| | - Nataša Marčun Varda
- Department of Pediatrics, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Taborska 8, 2000, Maribor, Slovenia
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Li J, Zhang YR, Ren JY, Li QL, Zhu PS, Du TT, Ge XY, Chen M, Cui XW. Association between diagnostic efficacy of acoustic radiation force impulse for benign and malignant thyroid nodules and the presence or absence of non-papillary thyroid cancer: A meta-analysis. Front Oncol 2023; 13:1007464. [PMID: 36776305 PMCID: PMC9915625 DOI: 10.3389/fonc.2023.1007464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 01/09/2023] [Indexed: 01/30/2023] Open
Abstract
Purpose The aim of this study was to investigate the diagnostic efficacy of Acoustic Radiation Force Impulse (ARFI) for benign and malignant thyroid nodules in the presence and absence of non-papillary thyroid cancer (NPTC) and to determine the cut-off values of Shear Wave Velocity (SWV) for the highest diagnostic efficacy of Virtual Touch Quantification (VTQ) and Virtual Touch Tissue Imaging and Quantification (VTIQ). Methods The diagnostic accuracy of ARFI for benign and malignant thyroid nodules was assessed by pooling sensitivity, specificity and area under the curve (AUC) in each group in the presence and absence of both non-papillary thyroid glands, using histology and cytology as the gold standard. All included studies were divided into two groups according to VTQ and VTIQ, and each group was ranked according to the magnitude of the SWV cutoff value to determine the SWV cutoff interval with the highest diagnostic efficacy for VTQ and VTIQ. Results A total of 57 studies were collected on the evaluation of ARFI for the diagnosis of benign and malignant thyroid nodules. The results showed that the presence of non-papillary thyroid carcinoma led to differences in the specificity of VTIQ for the identification of benign and malignant thyroid nodules, and the differences were statistically significant. In addition, the diagnostic efficacy of VTQ was best when the cutoff value of SWV was in the interval of 2.48-2.55 m/s, and the diagnostic efficacy of VTIQ was best when the cutoff value of SWV was in the interval of 3.01-3.15 m/s. Conclusion VTQ and VTIQ have a high diagnostic value for benign and malignant thyroid nodules; however, when the malignant nodules in the study contain non-papillary thyroid carcinoma occupying the thyroid gland, the findings should be viewed in a comprehensive manner.
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Affiliation(s)
- Jun Li
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China,*Correspondence: Jun Li, ; Xin Wu Cui,
| | - Yu-Rui Zhang
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Jia-Yu Ren
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiao-Li Li
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Pei-Shan Zhu
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Ting-Ting Du
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Xiao-Yan Ge
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Ming Chen
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Jun Li, ; Xin Wu Cui,
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Boers T, Braak SJ, Rikken NET, Versluis M, Manohar S. Ultrasound imaging in thyroid nodule diagnosis, therapy, and follow-up: Current status and future trends. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023. [PMID: 36655705 DOI: 10.1002/jcu.23430] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Ultrasound, the primary imaging modality in thyroid nodule management, suffers from drawbacks including: high inter- and intra-observer variability, limited field-of-view and limited functional imaging. Developments in ultrasound technologies are taking place to overcome these limitations, including three-dimensional-Doppler, -elastography, -nodule characteristics-extraction, and novel machine-learning algorithms. For thyroid ablative treatments and biopsies, perioperative use of three-dimensional ultrasound opens a new field of research. This review provides an overview of the current and future applications of ultrasound, and discusses the potential of new developments and trends that may improve the diagnosis, therapy, and follow-up of thyroid nodules.
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Affiliation(s)
- Tim Boers
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - Sicco J Braak
- Department of Radiology, Ziekenhuisgroep Twente, Hengelo, the Netherlands
| | - Nicole E T Rikken
- Department of Endocrinology, Ziekenhuisgroep Twente, Hengelo, the Netherlands
| | - Michel Versluis
- Physics of Fluids Group, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - Srirang Manohar
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
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Wang B, Ou X, Yang J, Zhang H, Cui XW, Dietrich CF, Yi AJ. Contrast-enhanced ultrasound and shear wave elastography in the diagnosis of ACR TI-RADS 4 and 5 category thyroid nodules coexisting with Hashimoto's thyroiditis. Front Oncol 2023; 12:1022305. [PMID: 36713579 PMCID: PMC9874292 DOI: 10.3389/fonc.2022.1022305] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
Objective This study aims to evaluate the value of contrast-enhanced ultrasound (CEUS), shear wave elastography (SWE), and their combined use in the differentiation of American College of Radiology (ACR) thyroid imaging reporting and data system (TI-RADS) 4 and 5 category thyroid nodules coexisting with Hashimoto's thyroiditis (HT). Materials and methods A total of 133 pathologically confirmed ACR TI-RADS 4 and 5 category nodules coexisting with HT in 113 patients were included; CEUS and SWE were performed for all nodules. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), accuracy, and the area under the receiver operating characteristic curve (AUC) of the SWE, CEUS, and the combined use of both for the differentiation of benign and malignant nodules were compared, respectively. Results Using CEUS alone, the sensitivity, specificity, PPV, NPV, and accuracy were 89.2%, 66.0%, 81.3%, 78.6%, and 80.5%, respectively. Using SWE alone, Emax was superior to Emin, Emean, and Eratio for the differentiation of benign and malignant nodules with the best cutoff Emax >46.8 kPa, which had sensitivity of 65.1%, specificity of 90.0%, PPV of 91.5%, NPV of 60.8%, and accuracy of 74.4%, respectively. Compared with the diagnostic performance of qualitative CEUS or/and quantitative SWE, the combination of CEUS and SWE had the best sensitivity, accuracy, and AUC; the sensitivity, specificity, PPV, NPV, accuracy, and AUC were 94.0%, 66.0%, 82.1%, 86.8%, 83.5%, and 0.80 (95% confidence interval: 0.713, 0.886), respectively. Conclusion In conclusion, CEUS and SWE were useful for the differentiation of benign and malignant ACR TI-RADS 4 and 5 category thyroid nodules coexisting with HT. The combination of CEUS and SWE could improve the sensitivity and accuracy compared with using CEUS or SWE alone. It could be a non-invasive, reliable, and useful method to differentiate benign from malignant ACR TI-RADS 4 and 5 category thyroid nodules coexisting with HT.
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Affiliation(s)
- Bin Wang
- Department of Medical Ultrasound, Yueyang Central Hospital, Yueyang, China
| | - Xiaoyan Ou
- Department of Medical Ultrasound, Yueyang Central Hospital, Yueyang, China
| | - Juan Yang
- Department of Medical Ultrasound, Yueyang Central Hospital, Yueyang, China
| | - Haibo Zhang
- Department of Medical Ultrasound, Yueyang Central Hospital, Yueyang, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Xin-Wu Cui, ; Ai-Jiao Yi,
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Ai-Jiao Yi
- Department of Medical Ultrasound, Yueyang Central Hospital, Yueyang, China,*Correspondence: Xin-Wu Cui, ; Ai-Jiao Yi,
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Bukasa-Kakamba J, Bayauli P, Sabbah N, Bidingija J, Atoot A, Mbunga B, Nkodila A, Atoot A, Bangolo AI, M'Buyamba-Kabangu JR. Ultrasound performance using the EU-TIRADS score in the diagnosis of thyroid cancer in Congolese hospitals. Sci Rep 2022; 12:18442. [PMID: 36323772 PMCID: PMC9630411 DOI: 10.1038/s41598-022-22954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/21/2022] [Indexed: 01/06/2023] Open
Abstract
The thyroid imaging reporting and data systems by the European Thyroid Association (EU-TIRADS) has been widely used in malignancy risk stratification of thyroid nodules. However, there is a paucity of data in developing countries, especially in Africa, to validate the use of this scoring system. The aim of the study was to assess the diagnostic value of the EU-TIRADS score in Congolese hospitals, using pathological examination after surgery as the gold standard in Congolese hospitals. This retrospective and analytical study examined clinical, ultrasound and pathological data of 549 patients aged 45 ± 14 years, including 468 females (85.2%), operated for thyroid nodule between January 2005 and January 2019. In the present study, only the highest graded nodule according to the EU-TIRADS score in each patient was taken into account for the statistical analyses. So 549 nodules were considered. Nodules classified EU-TIRADS 2 and 3 on the one hand, and, on the other hand, 4 and 5, were considered respectively at low and high risk of malignancy. The sensitivity and specificity of the EU-TIRADS score were calculated. The significance level was set at 5%. Of all patients, 21.7% had malignant nodules. They made 48.4% of the nodules in patients younger than and at 20 years old, and 31.1% in those aged 60 or over. Malignant nodules were more frequent in men than in women (30.9% vs. 20.1%; p = 0.024). Papillary carcinoma (67.2%) and follicular carcinoma (21.8%) were the main types. The malignancy rate was 39.7% and 1.5% among nodules rated EU-TIRADS 4 and 5, and those with EU-TIRADS score 2 and 3, respectively (p < 0.001). The EU-TIRADS score had a sensitivity of 96.6% and a specificity of 59.3%. The ROC curve indicated an area under the curve of 0.862. In a low-income country, a well performed thyroid ultrasound, using the EU-TIRADS score, could be an important tool in the selection of thyroid nodules suspected of malignancy and requiring histopathological examination in the Congolese hospital setting.Trial registration: The research protocol had obtained the favorable opinion of the DRC national health ethics committee no. 197/CNES/BN/PMMF/2020. The data was collected and analyzed anonymously.
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Affiliation(s)
- John Bukasa-Kakamba
- Department of Endocrinology, Metabolism and Nuclear Medicine, Kinshasa University Clinics, Kinshasa, Democratic Republic of the Congo.
- Department of Endocrinology, Metabolism and Nutrition, André Rosemon Hospital Center, University of Cayenne, Cayenne, French Guiana.
- Department of Endocrinology, Liege University Hospital Center, Liège, Belgium.
| | - Pascal Bayauli
- Department of Endocrinology, Metabolism and Nuclear Medicine, Kinshasa University Clinics, Kinshasa, Democratic Republic of the Congo
| | - Nadia Sabbah
- Department of Endocrinology, Metabolism and Nutrition, André Rosemon Hospital Center, University of Cayenne, Cayenne, French Guiana
- Antilles-French Guiana Clinical Investigation Center, Clinical Research Center (CIC), French National Institute of Health and Medical Research (INSERM) 1424, Cayenne Hospital Center, 97306, Cayenne, French Guiana
| | - Joseph Bidingija
- Department of Endocrinology, Metabolism and Nuclear Medicine, Kinshasa University Clinics, Kinshasa, Democratic Republic of the Congo
| | - Ali Atoot
- Department of Anesthesia, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Branly Mbunga
- Department of Family Medicine, Protestant University of Congo, Kinshasa, Democratic Republic of the Congo
| | - Aliocha Nkodila
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Department of Family Medicine, Protestant University of Congo, Kinshasa, Democratic Republic of the Congo
| | - Adam Atoot
- Department of Internal Medicine, Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
| | - Ayrton Ilolo Bangolo
- Department of Internal Medicine, Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA.
| | - Jean Rene M'Buyamba-Kabangu
- Department of Endocrinology, Metabolism and Nuclear Medicine, Kinshasa University Clinics, Kinshasa, Democratic Republic of the Congo.
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Brandenstein M, Wiesinger I, Künzel J, Hornung M, Stroszczynski C, Jung EM. Multiparametric Sonographic Imaging of Thyroid Lesions: Chances of B-Mode, Elastography and CEUS in Relation to Preoperative Histopathology. Cancers (Basel) 2022; 14:cancers14194745. [PMID: 36230668 PMCID: PMC9564296 DOI: 10.3390/cancers14194745] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 12/03/2022] Open
Abstract
Simple Summary As the incidence of thyroid lesions in Europe is rising, more and more people affected by thyroid pathologies seek treatment in a clinic. Every suspicious thyroid nodule needs to be confirmed as benign or malignant in order to be treated correctly. Unnecessary invasive diagnostics and thyroid surgery should be avoided. The aim of this retrospective study was to improve the distinction between benign and malignant nodules by using new high-performance multiparametric ultrasound examination techniques. By analyzing 122 thyroid nodules we created a score-based system combining B-mode, shear-wave elastography and contrast-enhanced ultrasound malignancy criteria. This system allows for a quite accurate detection of thyroid carcinomas with a sensitivity of 95% and specificity of 75.49%. Shear-wave elastography and contrast-enhanced ultrasound can detect unique malignancy features, which cannot be found in B-mode. Therefore, these criteria would present a relevant addition to the B-mode TI-RADS classification. Abstract Background: The aim was to improve preoperative diagnostics of solid non-cystic thyroid lesions by using new high-performance multiparametric ultrasound examination techniques. Methods: Multiparametric ultrasound consists of B-mode, shear-wave elastography and contrast enhanced ultrasound (CEUS) including Time-Intensity-Curve (TIC) analysis. A bolus of 1–2.4 mL Sulfur Hexafluorid microbubbles was injected for CEUS. Postoperative histopathology was the diagnostic gold standard. Results: 116 patients were included in this study. 102 benign thyroid nodules were diagnosed as well as 20 carcinomas. Suspicious B-mode findings like microcalcifications, a blurry edge and no homogeneous sonomorphological structure were detected in 60, 75 and 80% of all carcinomas but only in 13.7, 36.3 and 46.1% of all benign lesions. The average shear-wave elastography measurements of malignant lesions (4.6 m/s or 69.8 kPa centrally and 4.2 m/s or 60.1 kPa marginally) exceed the values of benign nodules. Suspicious CEUS findings like a not-homogeneous wash-in and a wash-out were detected almost twice as often in carcinomas. Conclusion: Multiparametric ultrasound offers new possibilities for the preoperative distinction between benign and malignant thyroid nodules. A score based system of B-mode, shear-wave and CEUS malignancy criteria shows promising results in the detection of thyroid carcinomas. It reaches a sensitivity of 95% and specificity of 75.49%.
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Affiliation(s)
- Moritz Brandenstein
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital, 93053 Regensburg, Germany
- Correspondence: ; Tel.: +49-17-647-793-303
| | - Isabel Wiesinger
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital, 93053 Regensburg, Germany
| | - Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, 93053 Regensburg, Germany
| | - Matthias Hornung
- Department of Surgery, University Hospital, 93053 Regensburg, Germany
| | - Christian Stroszczynski
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital, 93053 Regensburg, Germany
| | - Ernst-Michael Jung
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital, 93053 Regensburg, Germany
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11
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Li H, Bhatt M, Qu Z, Zhang S, Hartel MC, Khademhosseini A, Cloutier G. Deep learning in ultrasound elastography imaging: A review. Med Phys 2022; 49:5993-6018. [PMID: 35842833 DOI: 10.1002/mp.15856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 02/04/2022] [Accepted: 07/06/2022] [Indexed: 11/11/2022] Open
Abstract
It is known that changes in the mechanical properties of tissues are associated with the onset and progression of certain diseases. Ultrasound elastography is a technique to characterize tissue stiffness using ultrasound imaging either by measuring tissue strain using quasi-static elastography or natural organ pulsation elastography, or by tracing a propagated shear wave induced by a source or a natural vibration using dynamic elastography. In recent years, deep learning has begun to emerge in ultrasound elastography research. In this review, several common deep learning frameworks in the computer vision community, such as multilayer perceptron, convolutional neural network, and recurrent neural network are described. Then, recent advances in ultrasound elastography using such deep learning techniques are revisited in terms of algorithm development and clinical diagnosis. Finally, the current challenges and future developments of deep learning in ultrasound elastography are prospected. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hongliang Li
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada.,Institute of Biomedical Engineering, University of Montreal, Montréal, Québec, Canada
| | - Manish Bhatt
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada
| | - Zhen Qu
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada
| | - Shiming Zhang
- California Nanosystems Institute, University of California, Los Angeles, California, USA
| | - Martin C Hartel
- California Nanosystems Institute, University of California, Los Angeles, California, USA
| | - Ali Khademhosseini
- California Nanosystems Institute, University of California, Los Angeles, California, USA
| | - Guy Cloutier
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada.,Institute of Biomedical Engineering, University of Montreal, Montréal, Québec, Canada.,Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Montréal, Québec, Canada
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12
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Beyazal M, Beyazal MS, Çeliker FB, Devrimsel G, Yıldırım M. The Association of Achilles Sonoelastography Findings with Disease
Activity, Functional Status and Enthesitis Index in Patients with Axial
Spondyloarthritis. AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1749-4695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstract
Background Sonoelastography (SE) is a new ultrasound (US)-based technique
able to assess tissue elasticity. Using conventional US, it is sometimes
difficult or even impossible to distinguish pathologic tissue because it often
presents with the same echogenicity as the surrounding healthy tissue. This
study aimed to evaluate SE findings in Achilles tendons of patients with axial
spondyloarthritis (axSpA) and to assess how these findings are associated with
disease-related parameters.
Material and Methods Sixty-four consecutive patients (37 men, 27 women;
mean age 39.7 years; range 20–65 years) with axSpA and 30 sex and
age-matched healthy controls were enrolled in the study. Disease activity was
evaluated using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI),
whereas functional capacity was evaluated using the Bath Ankylosing Spondylitis
Functional Index (BASFI). Erythrocyte sedimentation rate (ESR), C-reactive
protein (CRP) and the Spondyloarthritis Research Consortium of Canada (SPARCC)
enthesitis index were recorded. All participants underwent an SE examination of
the Achilles tendon and measurement of the strain index (SI).
Results The mean right and left SI were significantly higher in axSpA
patients than in controls (2.96±0.94 vs. 1.90±0.45;
p<0.001; 2.95±0.95 vs. 1.92±0.48, p<0.001,
respectively). In axSpA patients, both right and left SI were significantly
correlated with the BASDAI, BASFI and SPARCC enthesitis indices, but not with
ESR or CRP.
Conclusion AxSpA patients had an increased SI compared with healthy
subjects and these values were associated with disease activity, functional
capacity and the enthesitis index. SE may be a useful tool for the evaluation of
Achilles tendons in patients with axSpA.
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Affiliation(s)
- Mehmet Beyazal
- Department of Radiology, Recep Tayyip Erdogan University Training and
Research Hospital, Rize, Turkey
| | - Münevver Serdaroğlu Beyazal
- Department of Physical Medicine and Rehabilitation, Recep Tayyip
Erdogan University Training and Research Hospital, Rize, Turkey
| | - Fatma Beyazal Çeliker
- Department of Radiology, Recep Tayyip Erdogan University Training and
Research Hospital, Rize, Turkey
| | - Gul Devrimsel
- Department of Physical Medicine and Rehabilitation, Recep Tayyip
Erdogan University Training and Research Hospital, Rize, Turkey
| | - Murat Yıldırım
- Department of Physical Medicine and Rehabilitation, Recep Tayyip
Erdogan University Training and Research Hospital, Rize, Turkey
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13
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Is Diagnostic Performance of Quantitative 2D-Shear Wave Elastography Optimal for Clinical Classification of Benign and Malignant Thyroid Nodules?: A Systematic Review and Meta-analysis. Acad Radiol 2022; 29 Suppl 3:S114-S121. [PMID: 29054676 DOI: 10.1016/j.acra.2017.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/03/2017] [Accepted: 09/03/2017] [Indexed: 12/17/2022]
Abstract
RATIONALE AND OBJECTIVE This study is a dedicated 2D-shear wave elastography (2D-SWE) review aimed at systematically eliciting up-to-date evidence of its clinical value in differential diagnosis of benign and malignant thyroid nodules. METHODS PubMed, Web of Science, and Scopus databases were searched for studies assessing the diagnostic value of 2D-SWE for thyroid malignancy risk stratification published until December 2016. The retrieved titles and abstracts were screened and evaluated according to the predefined inclusion and exclusion criteria. Methodological quality of the studies was assessed using the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review 2 (QUADAS-2) tool. Extracted 2D-SWE diagnostic performance data were meta-analyzed to assess the summary sensitivity, specificity, and area under the receiver operating characteristic curve. RESULTS After stepwise review, 14 studies in which 2D-SWE was used to evaluate 2851 thyroid nodules (1092 malignant, 1759 benign) from 2139 patients were selected for the current study. Study quality on QUADAS-2 assessment was moderate to high. The summary sensitivity, specificity and area under the receiver operating characteristic curve of 2D-SWE for differential diagnosis of benign and malignant thyroid nodules were 0.66 (95% confidence interval [CI]: 0.64-0.69), 0.78 (CI: 0.76-0.80), and 0.851 (Q* = 0.85), respectively. The pooled diagnostic odds ratio, negative likelihood ratio, and positive likelihood ratio were 12.73 (CI: 8.80-18.43), 0.31 (CI: 0.22-0.44), and 3.87 (CI: 2.83-5.29), respectively. CONCLUSION Diagnostic performance of quantitative 2D-SWE for malignancy risk stratification of thyroid nodules is suboptimal with mediocre sensitivity and specificity, contrary to earlier reports of excellence.
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14
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Xu S, Ni X, Zhou W, Zhan W, Zhang H. Development and validation of a novel diagnostic tool for predicting the malignancy probability of thyroid nodules: A retrospective study based on clinical, B-mode, color doppler and elastographic ultrasonographic characteristics. Front Endocrinol (Lausanne) 2022; 13:966572. [PMID: 36204114 PMCID: PMC9530571 DOI: 10.3389/fendo.2022.966572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 09/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Clinicians estimate the risk of thyroid nodules and make subsequently decision on the basis of clinical and ultrasonographic findings. Currently, there is no comprehensive diagnostic tool for predicting the malignancy rates of thyroid nodules. Our aim was to develop and validate a novel integrate diagnostic tool for predicting the malignancy probability of thyroid nodules based on clinical, B-mode, Color Doppler and elastographic ultrasonographic characteristics. METHODS A total of 1016 nodules in 1016 patients who underwent thyroid ultrasonography and surgery from July 2021 to December 2021 were included in this retrospective study. All nodules were confirmed by pathology and randomly classified into the training and validation groups. Clinical, B-mode, Color Doppler and elastographic (CBCE) ultrasonographic characteristics of nodules were recorded. Univariate and multivariate analyses were performed to screen independent predictors associated with thyroid cancer. A multivariate model containing the extracted predictors was constructed and presented in the form of a nomogram. The validation and applicability of the CBCE nomogram was evaluated using the receiver operating characteristic (ROC) curve. Diagnostic performances were calculated to compare the CBCE nomogram with ACR-TIRADS (Thyroid Imaging Reporting Data System by American College of Radiology) and EU-TIRADS (Thyroid Imaging Reporting Data System by European Thyroid Association). RESULTS The following factors were included in the CBCE nomogram: patient gender, age, shape, margin, composition and echogenicity, calcification, vascularization distribution, vascularization degree, suspicious lymph node metastases and elastography. The area under the curve (AUC) values were 0.978 and 0.983 for the training and validation groups, respectively. Compared with ACR-TIRADS and EU-TIRADS, the CBCE nomogram showed improved accuracy (0.944) and specificity (0.913) without sacrificing sensitivity (0.963) and showed the highest AUC with an optimal cutoff value of 0.55. CONCLUSION The CBCE nomogram has good and high clinical practicability in predicting the malignancy probability of thyroid nodules.
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Affiliation(s)
- Shangyan Xu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Ni
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Huan Zhang, ; Weiwei Zhan, ; Wei Zhou,
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Huan Zhang, ; Weiwei Zhan, ; Wei Zhou,
| | - Huan Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Huan Zhang, ; Weiwei Zhan, ; Wei Zhou,
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15
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Advanced Ultrasound Techniques for Differentiation of Benign Versus Malignant Thyroid Nodules: A Review. Ultrasound Q 2021; 37:315-323. [PMID: 34855707 DOI: 10.1097/ruq.0000000000000543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
ABSTRACT Grayscale ultrasound (US) is decisive in stratifying which thyroid nodules benefit from fine-needle aspiration to evaluate for malignancy. Unfortunately, a significant percentage of nodules remain indeterminate.Herein, we review the clinical considerations and diagnostic accuracy of advanced US, Doppler US, contrast-enhanced US, and US elastography techniques in the evaluation of indeterminate nodules.We conclude that these techniques may be used in combination with grayscale US to improve the assessment of lesion vascularity and tissue property.
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16
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Cheng MQ, Xian MF, Tian WS, Li MD, Hu HT, Li W, Zhang JC, Huang Y, Xie XY, Lu MD, Kuang M, Wang W, Ruan SM, Chen LD. RGB Three-Channel SWE-Based Ultrasomics Model: Improving the Efficiency in Differentiating Focal Liver Lesions. Front Oncol 2021; 11:704218. [PMID: 34646763 PMCID: PMC8504873 DOI: 10.3389/fonc.2021.704218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To explore a new method for color image analysis of ultrasomics and investigate the efficiency in differentiating focal liver lesions (FLLs) by Red, Green, and Blue (RGB) three-channel SWE-based ultrasomics model. Methods One hundred thirty FLLs were randomly divided into training set (n = 65) and validation set (n = 65). The RGB three-channel and direct conversion methods were applied to the same color SWE images. Ultrasomics features were extracted from the preprocessing images establishing two feature data sets. The least absolute shrinkage and selection operator (LASSO) logistic regression model was applied for feature selection and model construction. Two models, named RGB model (based on RGB three-channel conversion) and direct model (based on direct conversion), were used to differentiate FLLs. The diagnosis performance of the two models was evaluated by area under the curve (AUC), calibration curves, decision curves, and net reclassification index (NRI). Results In the validation cohort, the AUC of the direct model and RGB model in characterization on FLLs were 0.813 and 0.926, respectively (p = 0.038). Calibration curves and decision curves indicated that the RGB model had better calibration efficiency and provided greater clinical benefits. NRI revealed that the RGB model correctly reclassified 7% of malignant cases and 25% of benign cases compared to the direct model (p = 0.01). Conclusion The RGB model generated by RGB three-channel method yielded better diagnostic efficiency than the direct model established by direct conversion method. The RGB three-channel method may be promising on ultrasomics analysis of color images in clinical application.
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Affiliation(s)
- Mei-Qing Cheng
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Ultrasomics Artificial Intelligence X-Lab, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Meng-Fei Xian
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Ultrasomics Artificial Intelligence X-Lab, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wen-Shuo Tian
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Ultrasomics Artificial Intelligence X-Lab, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming-De Li
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Ultrasomics Artificial Intelligence X-Lab, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hang-Tong Hu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Ultrasomics Artificial Intelligence X-Lab, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wei Li
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Ultrasomics Artificial Intelligence X-Lab, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jian-Chao Zhang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Ultrasomics Artificial Intelligence X-Lab, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yang Huang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Ultrasomics Artificial Intelligence X-Lab, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Ultrasomics Artificial Intelligence X-Lab, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming-De Lu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Ultrasomics Artificial Intelligence X-Lab, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming Kuang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Ultrasomics Artificial Intelligence X-Lab, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wei Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Ultrasomics Artificial Intelligence X-Lab, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Si-Min Ruan
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Ultrasomics Artificial Intelligence X-Lab, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Li-Da Chen
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Ultrasomics Artificial Intelligence X-Lab, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Brandenstein M, Wiesinger I, Jung F, Stroszczynski C, Jung EM. High-performance sonographical multimodal imaging of non cystic thyroid lesions: Chances of the preoperative diagnostics in relation to histopathology. Clin Hemorheol Microcirc 2021; 79:27-38. [PMID: 34334387 PMCID: PMC8609687 DOI: 10.3233/ch-219101] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM: To improve preoperative diagnostics of solid non-cystic thyroid lesions by using new high-performance ultrasound techniques: optimized B-mode morphology, elastography, Color-Coded Doppler-Sonography (CCDS) and contrast enhanced ultrasound (CEUS) MATERIALS AND METHODS: In 33 cases solid, non-cystic thyroid lesions were rated as TIRADS 3 and up from conventional B-mode examinations. Additional high resolution Power Doppler including HR- and Glazing-Flow as optimized macrovascularization techniques, shear wave elastography and CEUS were performed on these patients by one experienced examiner. For CEUS a bolus of 1–2.4 ml Sulfurhexafluorid microbubbles (SonoVue®, Bracco, Milan, Italy) was injected into a cubital vein and then the distribution kinetics of the contrast agent were documented from the early arterial phase (10 to 15 seconds after injection) to the late venous phase (5 minutes after injection). Postoperative histopathology was the diagnostic gold standard as it provides the most reliable proof. RESULTS: 33 patients (13 males, 20 females; age 29 –77 years; mean 55 years; SD 13 years) were included in this study. 28 of them had benign regressive thyroid nodules, 3 had adenomas and 4 were diagnosed with carcinomas (3 were histologically identified as papillary thyroid carcinomas, one as a medullary thyroid carcinoma). The volume of the thyroid gland ranged from 6.6 to 401.3 cm2 (mean 72.6±92.0 cm2). The adenoma diameters ranged from 9 to 40 mm (mean 22±16 mm) and the carcinoma diameters ranged from 19 to 33 mm (mean 26±6 mm). The 3 adenomas had different echogenicities: One was completely echofree, one was hypoechoic and one isoechoic. The 4 carcinomas however were equally characterized as hypoechoic and echofree. Two of three adenomas and all of the carcinomas showed an incomplete or diffuse margin. Micro-calcifications were found in one adenoma and in every carcinoma. However, no micro-calcifications were observed in cases of benign regressive nodules. Performing shear-wave elastography the adenomas showed lower values than the carcinomas: The tissue velocity of the adenomas ranged from 2.86 m/s to 3.85 m/s (mean 3.32±0.5 m/s) and in carcinomas from 3.89 m/s to 5.66 m/s (mean 4.18±0.3 m/s). Marginal hypervascularization was detected in two adenomas after applying CCDS. One adenoma was hypovascularized. The four carcinomas showed an irregular extreme hypervascularization along their margins as well as an irregular central normo- or hypervascularization in CCDS. The additional HR-Flow helped reducing artefacts. In CEUS the dynamic capillary microvascularization of all carcinomas was very irregular with early enhancement and followed by partial or complete wash-out. In CEUS two adenomas had no wash-out and the other one showed a partial wash-out. CONCLUSION: Using modern multimodal imaging offers new possibilities for the differentiation between benign and malignant thyroid lesions. It is a very important diagnostic tool in addition to the B-Mode TIRADS classification and eases the decision between TIRADS 3, 4 and 5. However, additional multicenter studies are required for more detailed evaluations.
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Affiliation(s)
- M Brandenstein
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
| | - I Wiesinger
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
| | - F Jung
- Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology, Senftenberg, Germany
| | - C Stroszczynski
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
| | - E M Jung
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
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Hekimsoy İ, Öztürk E, Ertan Y, Orman MN, Kavukçu G, Özgen AG, Özdemir M, Özbek SS. Diagnostic performance rates of the ACR-TIRADS and EU-TIRADS based on histopathological evidence. ACTA ACUST UNITED AC 2021; 27:511-518. [PMID: 34313236 DOI: 10.5152/dir.2021.20813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE In this study, we aimed to assess the effectiveness of malignancy stratification algorithms of the American College of Radiology (ACR) and European Thyroid Association (ETA) in the delineation of thyroid nodules using a database of nodules that were unequivocally diagnosed by means of histopathological examination and meticulously matched with the imaged nodules. METHODS A total of 165 patients having 251 thyroid nodules with histopathologically proven definitive diagnoses during a 5-year period were included in this study. All patients had preoperatively undergone ultrasonography (US) examination, and US characteristics of the thyroid nodules were retrospectively analyzed and assigned in compliance with the thyroid imaging reporting and data system categories recommended by the ACR (ACR-TIRADS) and ETA (EU-TIRADS). The diagnostic effectiveness in the delineation of thyroid nodules and unnecessary fine-needle aspiration (FNAB) rates were evaluated. RESULTS Overall, 189 nodules (75.30%) were diagnosed as benign, while 62 nodules (24.70%) were reported to be malignant based on histopathological assessment. Sensitivity and specificity rates were 71% and 75% for ACR-TIRADS and 73% and 80% for EU-TIRADS. The area under the curve values were 0.78 and 0.80 for ACR-TIRADS and EU-TIRADS, respectively. The unnecessary FNAB rates were 61% for ACR-TIRADS and 64% for EU-TIRADS as per the recommended criteria of each algorithm. CONCLUSION The diagnostic performance of both malignancy stratification systems was signified to be moderate and sufficient in a cohort of nodules with definite histopathological diagnosis. In light of our results, we demonstrated the strengths and weaknesses of the ACR- and EU-TIRADS for physicians who should be familiar with them for optimal management of thyroid nodules.
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Affiliation(s)
- İlhan Hekimsoy
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Egemen Öztürk
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Yeşim Ertan
- Department of Pathology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mehmet Nurullah Orman
- Department of Biostatistics and Medical Informatics, Ege University Faculty of Medicine, İzmir, Turkey
| | - Gülgün Kavukçu
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ahmet Gökhan Özgen
- Department of Internal Medicine, Ege University Faculty of Medicine, İzmir, Turkey
| | - Murat Özdemir
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Süha Süreyya Özbek
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
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Zayed A, Rivaz H. Fast Strain Estimation and Frame Selection in Ultrasound Elastography Using Machine Learning. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:406-415. [PMID: 32406831 DOI: 10.1109/tuffc.2020.2994028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Ultrasound elastography aims to determine the mechanical properties of the tissue by monitoring tissue deformation due to internal or external forces. Tissue deformations are estimated from ultrasound radio frequency (RF) signals and are often referred to as time delay estimation (TDE). Given two RF frames I1 and I2 , we can compute a displacement image, which shows the change in the position of each sample in I1 to a new position in I2 . Two important challenges in TDE include high computational complexity and the difficulty in choosing suitable RF frames. Selecting suitable frames is of high importance because many pairs of RF frames either do not have acceptable deformation for extracting informative strain images or are decorrelated and deformation cannot be reliably estimated. Herein, we introduce a method that learns 12 displacement modes in quasi-static elastography by performing principal component analysis (PCA) on displacement fields of a large training database. In the inference stage, we use dynamic programming (DP) to compute an initial displacement estimate of around 1% of the samples and then decompose this sparse displacement into a linear combination of the 12 displacement modes. Our method assumes that the displacement of the whole image could also be described by this linear combination of principal components. We then use the GLobal Ultrasound Elastography (GLUE) method to fine-tune the result yielding the exact displacement image. Our method, which we call PCA-GLUE, is more than 10× faster than DP in calculating the initial displacement map while giving the same result. This is due to converting the problem of estimating millions of variables in DP into a much simpler problem of only 12 unknown weights of the principal components. Our second contribution in this article is determining the suitability of the frame pair I1 and I2 for strain estimation, which we achieve by using the weight vector that we calculated for PCA-GLUE as an input to a multilayer perceptron (MLP) classifier. We validate PCA-GLUE using simulation, phantom, and in vivo data. Our classifier takes only 1.5 ms during the testing phase and has an F1-measure of more than 92% when tested on 1430 instances collected from both phantom and in vivo data sets.
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Nair D, Kandiah S, Rourke T, Corbridge R, Nagala S. Malignancy rates and initial management of Thy3 thyroid nodules in a district general hospital: The 'Reading' experience. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00243. [PMID: 34277968 PMCID: PMC8279597 DOI: 10.1002/edm2.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/29/2021] [Accepted: 02/08/2021] [Indexed: 11/12/2022]
Abstract
Background Ultrasound-guided fine-needle aspiration cytology is the gold standard for investigating thyroid nodules. Stratifying the Thy3 thyroid nodule risk of malignancy is essential for clinical decision-making. According to the Royal College of Pathologists Guidance (2016), the rate of malignancy for Thy3a is 5-15% and for Thy3f 15-30%. Our aim was to investigate the malignancy rate and the initial management of Thy3 nodules in our institution. Methods A retrospective review was undertaken of 115 patients with Thy3 cytology results from thyroid fine-needle aspirations performed between January 2015 and June 2020 at a single centre. A total of 90 out of 115 patients underwent surgery. Results Of the 90 patients, we had a 40% malignant rate (36/90). Specifically, 14 of 34 (41.1%) Thy3a and 22 of 56 (39.2%) Thy3f nodules were malignant. Of the malignant lesions, 52.7% (19/36) were follicular thyroid carcinoma. 58.8% (10/17) of male patients and 35.6% (26/73) of female patients had a malignant histology. Eighteen patients eventually needed a completion thyroidectomy. Conclusion Compared with national data, we showed a higher risk of malignancy in Thy3 nodules in our centre. Our study should encourage other centres to audit their own data. We propose setting up a national Thy3 registry as a basis to promote research in improving preoperative diagnosis of indeterminate thyroid nodules.
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Affiliation(s)
- Dilip Nair
- Department of ENT Royal Berkshire NHS Foundation Trust Hospital Reading Berkshire UK
| | - Shivanthi Kandiah
- Department of ENT Royal Berkshire NHS Foundation Trust Hospital Reading Berkshire UK
| | - Thomas Rourke
- Department of ENT Royal Berkshire NHS Foundation Trust Hospital Reading Berkshire UK
| | - Rogan Corbridge
- Department of ENT Royal Berkshire NHS Foundation Trust Hospital Reading Berkshire UK
| | - Sidhartha Nagala
- Department of ENT Royal Berkshire NHS Foundation Trust Hospital Reading Berkshire UK
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Shear-Wave Elastography-Diagnostic Value in Children with Chronic Autoimmune Thyroiditis. Diagnostics (Basel) 2021; 11:diagnostics11020248. [PMID: 33562689 PMCID: PMC7915688 DOI: 10.3390/diagnostics11020248] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/17/2022] Open
Abstract
Chronic autoimmune thyroiditis (CAT) is the most common thyroid disorder in the pediatric population. Ultrasound evaluation may suggest the diagnosis. Additionally, shear-wave elastography (SWE) proved to be a valuable additional diagnosis tool in adults with CAT by assessing thyroid stiffness (TS). This study aims to assess its use also in detecting children with CAT. The study group consisted of 50 children with confirmed diagnosis of CAT, who were compared to the control group, consisting of 50 children with no thyroid pathology and with an adult group of 50 subjects with CAT. The evaluation included, besides bioimmunochemical evaluation, also thyroid ultrasound evaluation and elastography measurements in the same session (Aixplorer Mach 30, Supersonic imagine, France). The mean TS values were significantly lower for children in the CAT group compared to adults with CAT (15.51 ± 4.76 kPa vs. 20.96 ± 6.31 kPa; p < 0.0001) and higher compared to the healthy aged matched controls (15.51 ± 4.76 kPa vs. 10.41 ± 2.01 kPa; p < 0.0001). SWE elastography definitely seems a promising technique in the evaluation of children with autoimmune thyroid pathology.
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Evaluation of thyroid micro-carcinoma using shear wave elastography: Initial experience with qualitative and quantitative analysis. Eur J Radiol 2021; 137:109571. [PMID: 33636489 DOI: 10.1016/j.ejrad.2021.109571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/10/2021] [Accepted: 01/24/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We aimed to assess the diagnostic performance of shear wave elastography (SWE) to assess perinodular stiffness before fine needle aspiration (FNA) of thyroid nodules with a maximum diameter of 1.0 cm. METHOD This retrospective study included 69 thyroid nodules in 68 patients who underwent conventional ultrasound and SWE before ultrasound-guided FNA or surgical excision. The stiffness of perinodular regions was evaluated using wave patterns. Quantitative SWE features were also assessed. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve were calculated using conventional ultrasound and conventional ultrasound with SWE. RESULTS Of the 69 nodules, 57(82.6 %)were malignant and 12(17.4 %)were benign. The maximum elastic modulus (Emax) was higher for malignant nodules(P< 0.05). There was no significant difference in mean elastic modulus or minimum elastic modulus between malignant and benign nodules. The Emax≥ 28.2 kPa was the best cut-off value for malignant base on receiver operating curve. Perinodular stiffness was significantly greater for malignant nodules compared with benign nodules according to shear wave patterns. Compared with ultrasound alone, the rate of benign lesions recommended for FNA decreased from 75.0 % (9/12) to 25.0 % (3/12) with conventional ultrasound plus SWE. CONCLUSION SWE provides quantitative and qualitative information when used with conventional ultrasound. SWE has the potential to reduce the number of unnecessary FNA procedures.
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Update on ACR TI-RADS: Successes, Challenges, and Future Directions, From the AJR Special Series on Radiology Reporting and Data Systems. AJR Am J Roentgenol 2021; 216:570-578. [PMID: 33112199 DOI: 10.2214/ajr.20.24608] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) is an ultrasound-based risk stratification system (RSS) for thyroid nodules that was released in 2017. Since publication, research has shown that ACR TI-RADS has a higher specificity than other RSSs and reduces the number of unnecessary biopsies of benign nodules compared with other systems by 19.9-46.5%. The risk of missing significant cancers using ACR TI-RADS is mitigated by the follow-up recommendations for nodules that do not meet criteria for biopsy. In practice, after a nodule's ultrasound features have been enumerated, the ACR TI-RADS points-based approach leads to clear management recommendations. Practices seeking to implement ACR TI-RADS must engage their radiologists in understanding how the system addresses the problems of thyroid cancer overdiagnosis and unnecessary surgeries by reducing unnecessary biopsies. This review compares ACR TI-RADS to other RSSs and explores key clinical questions faced by practices considering its implementation. We also address the challenge of reducing interobserver variability in assigning ultrasound features. Finally, we highlight emerging imaging techniques and recognize the ongoing international effort to develop a system that harmonizes multiple RSSs, including ACR TI-RADS.
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Adamczewski Z, Stasiak M, Stasiak B, Adamczewska M, Lewiński A. Interobserver Agreement and Plane-Dependent Intraobserver Variability of Shear Wave Sonoelastography in the Differential Diagnosis of Ectopic Thymus Tissue. J Clin Med 2021; 10:jcm10020214. [PMID: 33435276 PMCID: PMC7827397 DOI: 10.3390/jcm10020214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/30/2020] [Accepted: 01/07/2021] [Indexed: 12/24/2022] Open
Abstract
Shear wave elastography (SWE) has been demonstrated to be a useful tool in the differential diagnosis of ectopic thymus tissues (ETs), providing quantitative values of the shear wave stiffness (SWS) of both ETs and adjacent thyroid tissue. However, no data are available on the potential influence of the imaging plane (transverse vs. longitudinal) on the obtained SWS and shear wave ratio (SWR) values in SWE of these tissues. Moreover, no reports on the interobserver repeatability of SWE were published in regard to ETs. The aim of this study has been to evaluate the potential influence of the examination plane—transverse vs. longitudinal—on the SWS and SWR results, as well as to determine whether SWE of ETs is subjected to interobserver variability. SWE was demonstrated to have high inter- and intraobserver agreement in the evaluation of ETs and adjacent thyroid tissue. Significant differences between SWS values, but not SWR values, obtained in the transverse and longitudinal planes were observed. This phenomenon is probably a result of anisotropy-related artifacts and does not reduce the reliability of the method. SWE operators should be aware of the presence of plane-dependent artifacts to properly interpret the obtained results.
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Affiliation(s)
- Zbigniew Adamczewski
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland; (Z.A.); (M.S.)
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338 Lodz, Poland;
| | - Magdalena Stasiak
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland; (Z.A.); (M.S.)
| | - Bartłomiej Stasiak
- Institute of Information Technology, Lodz University of Technology, 90-924 Lodz, Poland;
| | - Magdalena Adamczewska
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338 Lodz, Poland;
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland; (Z.A.); (M.S.)
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338 Lodz, Poland;
- Correspondence: ; Tel.: +48-42-271–11-42
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Han DY, Sohn YM, Seo M, Yun SJ, Park WS, Jeon SH, Cho YH. Shear-wave elastography in thyroid ultrasound: Can be a predictor of extrathyroidal extension and cervical lymph node metastasis in papillary thyroid carcinoma? Medicine (Baltimore) 2020; 99:e23654. [PMID: 33350745 PMCID: PMC7769340 DOI: 10.1097/md.0000000000023654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/19/2020] [Accepted: 11/12/2020] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT This study aimed to investigate whether extrathyroidal extension (ETE) and cervical lymph node metastasis (LNM) can be predicted using elasticity parameters of shear-wave elastography (SWE) combined with B-mode ultrasound (US) of papillary thyroid carcinomas (PTCs).We retrospectively reviewed 111 patients who underwent preoperative SWE evaluation among PTC patients from July 1, 2016 to June 20, 2018. Patients were divided into 2 groups based on the presence or absence of ETE based on pathology reports. Univariate and multivariate analyses of clinical and radiologic features including B-mode US features, US patterns, and SWE parameters were performed. These analyses were repeated in LNM positive and negative groups. The diagnostic performance of SWE parameters were also evaluated.Of the 111 patients, 33 had ETE, 78 did not have ETE, 44 had LNM, and 67 did not have LNM. A taller-than-wide shape and T3 stage on US were associated with ETE. Female sex, total thyroidectomy, and T3 stage on US were associated with LNM. When B-mode US and SWE were combined, there was no improvement in diagnostic performance.Combination of SWE and B-mode US findings is not useful for predicting ETE and LNM status in PTC patients.
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Affiliation(s)
- Dong Yoon Han
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul
| | - Yu-Mee Sohn
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul
| | - Mirinae Seo
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul
| | - Seong Jong Yun
- Department of Radiology, G SAM Hospital, 591 Gunpo-ro, Gunpo-si, Gyeonggi-do
| | - Won Seo Park
- Department of Surgery, Kyung Hee University Hospital, College of Medicine, Kyung Hee University
| | - Seok Ho Jeon
- Department of Anesthesiology and Pain Medicine, Seoul Sacred Heart General Hospital, 259 Wangsan-ro, Dongdaemun-gu, Seoul, South Korea
| | - Yong Hyun Cho
- Department of Anesthesiology and Pain Medicine, Seoul Sacred Heart General Hospital, 259 Wangsan-ro, Dongdaemun-gu, Seoul, South Korea
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Cepeha CM, Paul C, Borlea A, Borcan F, Fofiu R, Dehelean CA, Stoian D. The Value of Strain Elastography in Predicting Autoimmune Thyroiditis. Diagnostics (Basel) 2020; 10:diagnostics10110874. [PMID: 33121150 PMCID: PMC7692451 DOI: 10.3390/diagnostics10110874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 12/19/2022] Open
Abstract
Chronic autoimmune thyroiditis (CAT) defines a diffuse intrathyroidal lymphocytic infiltration associating a destructive process of the thyroid follicles, most commonly in evolution developing hypothyroidism. Typical ultrasound changes may suggest the presence of the disease. This study aims to evaluate the performance of strain elastography in detecting autoimmune thyroiditis as an additional tool to the conventional ultrasound examination. A total of 250 patients were enrolled in the study; 180 had biochemical confirmation of CAT, the other 70 healthy subjects represented the control group. All patients were examined clinically and by means of conventional thyroid ultrasound (US) and real-time elastography using a Hitachi Preirus machine (5–15 MHz linear probe). Five valid measurements for the parenchyma/muscle strain ratios (SR) were taken for each subject, considering the mean value for analysis. A mean SR value above 1.64 was found to predict the presence of CAT with sensitivity (Sen) 69%, specificity p92%, positive predictive value (PPV) 95.4%, negative predictive value (NPV) 54% and area under receiver operating characteristic (AUROC) 0.87. Moreover, when comparing the mean values for SR, significantly higher values were found in CAT patients compared with the controls (2.81 ± 2.11 vs. 1.03 ± 0.51; p < 0.0001). Of the 180 CAT subjects, 92 were on thyroid hormone replacement therapy; significantly higher values were detected for patients under therapy compared with asymptomatic cases (3.45 ± 2.53 vs. 2.15 ± 1.27, p < 0.0001). A cut-off value of 2.94 was established for identifying CAT patients who needed hormonal treatment (Sen 52.3%, Sp 83.7%, PPV 75.4%, NPV 64.7% and AUROC 0.66). No correlation was found between stiffness and antibody titers nor for functional status. Elastography does add valuable information to the US evaluation of cases with autoimmune thyroiditis.
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Affiliation(s)
- Cristina Mihaela Cepeha
- PhD School Department, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.M.C.); (R.F.)
- Department of Internal Medicine II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Corina Paul
- Department of Pediatrics, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence: (C.P.); (A.B.)
| | - Andreea Borlea
- PhD School Department, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.M.C.); (R.F.)
- Department of Internal Medicine II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Correspondence: (C.P.); (A.B.)
| | - Florin Borcan
- Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (F.B.); (C.A.D.)
| | - Renata Fofiu
- PhD School Department, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.M.C.); (R.F.)
- Department of Internal Medicine II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Cristina Adriana Dehelean
- Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (F.B.); (C.A.D.)
| | - Dana Stoian
- Department of Internal Medicine II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
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Ferraz C. The run for a million continues: is there still space for traditional techniques beyond molecular testing for indeterminate thyroid nodule cytology? ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:329-330. [PMID: 32813761 PMCID: PMC10522093 DOI: 10.20945/2359-3997000000277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Carolina Ferraz
- Departamento de MedicinaFaculdade de Ciências MédicasSanta Casa de São PauloSão PauloSPBrasil Unidade de Doenças da Tireoide, Divisão de Endocrinologia, Departamento de Medicina, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
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Tsitlakidis A, Aifantis EC, Kritis A, Tsingotjidou AS, Cheva A, Selviaridis P, Foroglou N. Mechanical properties of human glioma. Neurol Res 2020; 42:1018-1026. [PMID: 32705967 DOI: 10.1080/01616412.2020.1796381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Brain gliomas represent some of the most aggressive tumors encountered by modern medicine and, despite major efforts to optimize early diagnosis and treatment, the prognosis remains poor. Due to the complex structure of the brain and the unique mechanical properties of the extracellular matrix, gliomas invade and expand into the brain parenchyma, along white matter tracts and within perivascular spaces, usually sparing normal vessels. Different methods have been developed to study the mechanical properties of gliomas in a wide range of scales, from cells and the microscale to tissues and the macroscale. In this review, the current view on glioma mechanics is presented and the methods used to determine glioma mechanical properties are outlined. Their principles and current state of affairs are discussed.
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Affiliation(s)
- Abraham Tsitlakidis
- First Department of Neurosurgery, AHEPA University Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Elias C Aifantis
- Laboratory of Mechanics and Materials, Polytechnic School, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Aristeidis Kritis
- Laboratory of Physiology, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Anastasia S Tsingotjidou
- Laboratory of Anatomy, Histology and Embryology, School of Veterinary Medicine, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Angeliki Cheva
- Department of Pathology, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Panagiotis Selviaridis
- First Department of Neurosurgery, AHEPA University Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Nicolas Foroglou
- First Department of Neurosurgery, AHEPA University Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece
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Görgülü O, Görgülü FF, Koç AS. Can the unnecessary operations for suspected thyroid nodules be avoided by the combined use of the strain ratio and elastography score? Braz J Otorhinolaryngol 2020; 87:338-345. [PMID: 32653346 PMCID: PMC9422504 DOI: 10.1016/j.bjorl.2020.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/06/2020] [Accepted: 05/18/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Only 5%–15% of thyroid surgical specimens are reported as malignant. Most of the operations are performed due to suspicion of malignancy as a result of fine needle aspiration biopsy but invasiveness, non-diagnostic results and potential repeat biopsies are disadvantages of fine needle aspiration biopsy. Objective The aim of this study was to investigate the effectiveness of simultaneously using both the strain ratio and elasticity score in the differential diagnosis of thyroid nodules, as well as to assess the compatibility of these two methods. Methods A total of 144 nodules were included in the study. The final histopathologic diagnosis was used as the reference standard. The area under the curve sensitivity, specificity, and cut-off values of the strain ratio and elasticity score were determined using receiver operating characteristic curve analysis. The compatibility and comparison of strain ratio and elasticity score were also performed. Results Twenty eight nodules (19.4%) were malignant. The strain ratio and elasticity score results were found to be significantly successful in predicting thyroid malignancy (p < 0.001 for both). Moreover, the area under the curve for the strain ratio and elasticity score were found to be 0.944 and 0.960, respectively. The diagnostic accuracy of the elasticity score was found to be superior to that of the strain ratio, but this difference was not statistically significant (p = 0.456). When the compatibility of the strain ratio and elasticity score was examined, the two evaluations were revealed to be statistically consistent with each other (Kappa = 0.767; p < 0.001). When the strain ratio and the elasticity score were used together, the specificity of capturing the correct diagnosis increased from 84.5% to 93.1%. Conclusion When the strain ratio an elasticity score were used together for the differential diagnosis of thyroid nodules, more accurate results were obtained. Thus, combining both methods may be a promising alternative to fine needle aspiration biopsy in order to prevent unnecessary surgical interventions for suspected thyroid nodules.
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Affiliation(s)
- Orhan Görgülü
- University of Health Sciences, Adana Health Practice and Research Center, Department of Otorhinolaryngology, Adana, Turkey.
| | - Feride Fatma Görgülü
- University of Health Sciences, Adana Health Practice and Research Center, Radiology Department, Adana, Turkey
| | - Ayşe Selcan Koç
- University of Health Sciences, Adana Health Practice and Research Center, Radiology Department, Adana, Turkey
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Goel S, Malhotra A, Agarwal A, Chandak S, Kumar A, Khan A. Comparative Efficacy of Ultrasonography and Acoustic Radiation Force Impulse (ARFI) Elastography in Prediction of Malignancy in Thyroid Nodules. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479320931354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: The incidence of malignancy in thyroid nodules is infrequent, but this trend may be reversing. The present study was conducted to emphasize the diagnostic accuracy of acoustic radiation force impulse (ARFI) imaging, in addition to conventional gray-scale ultrasonography (US), for differentiating benign and malignant thyroid nodules. Methods: A total of 141 patients with thyroid nodules (≥10 mm) were included in the study and were evaluated with US, Doppler, and ARFI elastography using Siemens S2000 Acuson ultrasound equipment. Results: The sonographic patterns most predictive and indicative of malignancy included irregular margins and presence of microcalcifications. The Doppler findings in isolation were not extremely sensitive in the detection of malignancy. The shear wave velocity cutoff value on ARFI imaging using receiver operating characteristic curves for differentiation of benign and malignant nodules were noted at 2.87 m/s. ARFI imaging performed better than US and Doppler with sensitivity of 75%, specificity of 96%, and accuracy of 94%. Conclusion: ARFI elastography could be utilized as a reliable initial screening test for detection of malignancy in thyroid nodules.
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Affiliation(s)
- Sarika Goel
- Department of Radiodiagnosis, Teerthanker Mahaveer Medical College & Research Centre (TMMC&RC), Moradabad, Uttar Pradesh, India
| | - Ankur Malhotra
- Department of Radiodiagnosis, Teerthanker Mahaveer Medical College & Research Centre (TMMC&RC), Moradabad, Uttar Pradesh, India
| | - Arjit Agarwal
- Department of Radiodiagnosis, Teerthanker Mahaveer Medical College & Research Centre (TMMC&RC), Moradabad, Uttar Pradesh, India
| | - Shruti Chandak
- Department of Radiodiagnosis, Teerthanker Mahaveer Medical College & Research Centre (TMMC&RC), Moradabad, Uttar Pradesh, India
| | - Ashutosh Kumar
- Department of Pathology, Teerthanker Mahaveer Medical College & Research Centre (TMMC&RC), Moradabad, Uttar Pradesh, India
| | - Adil Khan
- Department of Radiodiagnosis, Teerthanker Mahaveer Medical College & Research Centre (TMMC&RC), Moradabad, Uttar Pradesh, India
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[Nodular goiter]. Chirurg 2020; 91:712-719. [PMID: 32548696 DOI: 10.1007/s00104-020-01218-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The indications for surgery of benign goiter should be balanced and professional as the prevalence of benign nodular goiter in Germany is high and not all goiters must be surgically treated. Thyroid nodules are detected in up to 76% of healthy people using modern high-resolution ultrasound (US) and only a few of these nodules are malignant or symptomatic. Even today a thorough medical history, detailed examination of the neck region, a qualified US of the thyroid gland, a 99m-technetium scintigraphy and fine needle aspiration help to select patients who will benefit from thyroid surgery. In the last 10 years several thyroid imaging reporting and data systems (TI-RADS) classifications have been introduced. The TI-RADS classification is a standardized assessment of thyroid nodules and risk stratification system in thyroid US which helps to select those nodules with a high risk of cancer. Asymptomatic euthyroid nodular goiter without any suspicion of malignancy and scintigraphically cold thyroid nodules without any other evidence of malignancy are not indications for thyroid surgery. The decision to operate should be made on an interdisciplinary basis in conformity with the relevant guidelines and exhaustion of diagnostic tools.
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Bakkar S, Macerola E, Proietti A, Aljarrah Q, Al-Omar K, Materazzi G, Basolo F, Miccoli P. Developing a tool that could reliably refute total thyroidectomy for solitary Bethesda IV thyroid nodules. Updates Surg 2020; 73:281-288. [PMID: 32410160 DOI: 10.1007/s13304-020-00783-w] [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: 11/21/2019] [Accepted: 05/02/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess the reliability of a simple, accessible, cost-effective rule-out tool, for use in triaging patients with Bethesda IV nodules to appropriate surgery. METHODS The diagnostic tool was assembled by combining the negativity for suspicious ultrasound features (irregular margins, microcalcification, and a taller-than-wide orientation), and mutational marker negativity (BRAF and NRAS). The tool, (US-/mutation-), was tested on 167 patients with solitary Bethesda IV nodules. The primary outcome was its negative predictive value (NPV) for lesions requiring total thyroidectomy (TT). The impact of mutational marker negativity, as part of the tool, was evaluated by comparing the NPV of (US-/mutation-) to that of (US-/mutation+). RESULTS 10 out of 167 lesions were positive for a mutational marker. These underwent TT, and only 2/10 (20%) were benign, on final histology. In 6/8 malignant lesions, TT was concordant with current clinical guidelines. 157 patients comprised the negative study cohort, for both mutational markers and suspicious US features. These underwent thyroid lobectomy, and 17 cases resulted in malignancy, only 8 of which required completion thyroidectomy. Accordingly, the NPV of (US-/mutation-) for malignancy was 89% (140/157), and 95% (149/157) for malignancy requiring TT. However, the NPV of (US-/mutation+) was 20% for malignancy, and 40% for malignancy requiring TT. These differences were statistically significant (89% vs. 20%; p < 0.0001, and 95% vs. 40%; p < 0.0001). CONCLUSION US-/mutation- is a reliable rule-out tool, with sufficient diagnostic accuracy to spare patients, with Bethesda IV nodules, an overly radical TT.
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Affiliation(s)
- Sohail Bakkar
- Department of Surgery, Faculty of Medicine, The Hashemite University, Zarqa, 13133, Jordan.
| | - Elisabetta Macerola
- Department of Surgical, Medical, Pathology, and Critical Care, The University of Pisa, 56124, Pisa, Italy
| | - Agnese Proietti
- Department of Surgical, Medical, Pathology, and Critical Care, The University of Pisa, 56124, Pisa, Italy
| | - Qusai Aljarrah
- Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Khaled Al-Omar
- Department of Surgery, Faculty of Medicine, The Hashemite University, Zarqa, 13133, Jordan
| | - Gabriele Materazzi
- Department of Surgical, Medical, Pathology, and Critical Care, The University of Pisa, 56124, Pisa, Italy
| | - Fulvio Basolo
- Department of Surgical, Medical, Pathology, and Critical Care, The University of Pisa, 56124, Pisa, Italy
| | - Paolo Miccoli
- Department of Surgical, Medical, Pathology, and Critical Care, The University of Pisa, 56124, Pisa, Italy
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TI-RADS Diagnostic Performance: Which Algorithm is Superior and How Elastography and 4D Vascularity Improve the Malignancy Risk Assessment. Diagnostics (Basel) 2020; 10:diagnostics10040180. [PMID: 32225078 PMCID: PMC7235757 DOI: 10.3390/diagnostics10040180] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 12/14/2022] Open
Abstract
Given the increased prevalence of thyroid nodules in the general population (~50%), the real challenge resides in correctly recognizing the suspicious ones. This study proposes to compare four important Thyroid Imaging and Reporting Data Systems (TI-RADS) and evaluate the contribution of elastography and 4D Color Doppler assessment of vascularity in estimating the risk of malignancy. In the study, 133 nodules with histopathological examination were included. Of these, 35 (26.31%) proved to be malignant. All nodules were classified using the four selected systems and our proposed improved score. The American College of Radiology (ACR) and EU TI-RADS had good sensitivity (94.28%, 97.14%) and NPV (93.33%, 95.83%), but fairly poor specificity (31.81%, 23.46%) and PPV (35.48%, 31.19%), with an accuracy of 42.8% and 45.8%, respectively. Horvath TI-RADS had better accuracy of 66.9% and somewhat improved specificity (62.24%), but poorer sensitivity (80%). Russ’ French TI-RADS includes elastography in the risk assessment strategy. This classification proved superior in all aspects (Se: 91.42%, Sp:82.65%, NPV:96.42%, PPV:65.30%, and Acc of 84.96%). The mean strain ratio (SR) value for malignant lesions was 5.56, while the mean SR value for benign ones was significantly lower, 2.54 (p < 0.05). It also correlated well with the response variable: histopathological result (p < 0.001). Although, adding 4D vascularity to the French score generated a similar calculated accuracy and from a statistical point of view, the parameter itself proved beneficial for predicting the malignancy risk (p < 0.001) and may add important knowledge in uncertain situations. Advanced ultrasound techniques definitely improved the risk estimation and should be used more extensively.
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Aghaghazvini L, Maheronnaghsh R, Soltani A, Rouzrokh P, Chavoshi M. Diagnostic value of shear wave sonoelastography in differentiation of benign from malignant thyroid nodules. Eur J Radiol 2020; 126:108926. [PMID: 32171916 DOI: 10.1016/j.ejrad.2020.108926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/27/2020] [Accepted: 02/27/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To study the efficacy of shear wave elastography (SWE), using both qualitative and quantitative methods, alone and in conjunction with other B-mode features. METHOD 117 patients with 123 nodules were studied both by conventional ultrasonography and SWE. Size, echogenicity, margins, internal calcification (micro- or macro-calcification), composition, shape and color Doppler were assessed for each nodule. The elasticity was assessed both qualitatively and quantitatively. Velocity in the ROI (Region of Interest) was calculated in the stiffest portions for 3 times, and maximum and mean velocity were obtained. ROC curve was analyzed to calculate the best cut-off value of the SWV (Shear Wave Velocity). Univariate logistic regression was used to examine the maximum and mean SWV as discrete variables and the results were compared to key variables of conventional US (Ultrasound) features. RESULT 123 nodules in 117 patients were evaluated. Poor margins, hypoechogenicity, micro-calcification, color Doppler grades III and IV, color map grades IV and V, maximum and minimum velocity had significant correlation with malignancy. The highest Nagelkerke R2 belonged to maximum and mean velocity (R2 = 41.2 and 39 respectively) which propose them as the strongest predictors of malignancy. The best cut-off point for differentiation of benign from malignant nodules was 3.63 m/s for maximum velocity (sensitivity of 90 %, specificity of 78.2 %,) and 3.44 m/s for mean velocity (sensitivity of 90 %, specificity of 76.4 %). CONCLUSION The Real-time SWE is a promising test for the preoperative malignancy risk stratification of patients and maximum velocity has the strongest predictive value for both conventional and elastography variables.
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Affiliation(s)
- Leila Aghaghazvini
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Aleahmed Highway, Tehran, Iran.
| | - Radin Maheronnaghsh
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Aleahmed Highway, Tehran, Iran.
| | - Akbar Soltani
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Science Institute, Tehran University of Medical Sciences, Shariati Hospital, Aleahmed Highway, Tehran, Iran.
| | - Pouria Rouzrokh
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Science Institute, Tehran University of Medical Sciences, Shariati Hospital, Aleahmed Highway, Tehran, Iran.
| | - Mohammadreza Chavoshi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Aleahmed Highway, Tehran, Iran.
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Belciug S. The beginnings. Artif Intell Cancer 2020. [DOI: 10.1016/b978-0-12-820201-2.00002-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Manchanda S, Vora Z, Sharma R, Hari S, Das CJ, Kumar S, Kachhawa G, Khan MA. Quantitative Sonoelastographic Assessment of the Normal Uterus Using Shear Wave Elastography: An Initial Experience. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3183-3189. [PMID: 31077426 DOI: 10.1002/jum.15019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/08/2019] [Accepted: 04/18/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To describe the sonoelastographic characteristics of the normal endometrium, myometrium, and cervix and to assess their variability with age and different menstrual phases. METHODS A total of 56 women were enrolled in this prospective study, who underwent transvaginal ultrasound examinations, including B-mode imaging and shear wave elastography. The elasticity parameters (in kilopascals) of the normal endometrium, myometrium, and cervix were studied. The variability of the mean elasticity value of the endometrium in different menstrual phases and age groups was analyzed. The variability of the mean elasticity of the cervix across different age groups was also studied. RESULTS The mean age of the participants was 40 years (range, 25-69 years). The normal mean elasticity values ± SDs were 25.54 ± 8.56 kPa for the endometrium, 40.24 ± 8.59 kPa for the myometrium, and 18.90 ± 4.22 kPa for the cervix. A mean endometrial-to-myometrial elasticity ratio was calculated, which was found to be 0.65 ± 0.22. There was no significant difference in the mean endometrial elasticity values for women in different menstrual phases (P = .176) or in different age groups (P = .376). There was no significant difference in the mean cervical elasticity with age (P = .192). CONCLUSIONS Shear wave elastography is a promising adjunct to ultrasound for the evaluation of the uterus, and the results from this study may provide normal data, which may further help in diagnosing various uterine diseases.
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Affiliation(s)
- Smita Manchanda
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Zainab Vora
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Smriti Hari
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Chandan Jyoti Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Sunesh Kumar
- Department of Gynecology and Obstetrics, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Gynecology and Obstetrics, All India Institute of Medical Sciences, New Delhi, India
| | - Maroof Ahmad Khan
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Görgülü FF. Which Is the Best Reference Tissue for Strain Elastography in Predicting Malignancy in Thyroid Nodules, the Sternocleidomastoid Muscle or the Thyroid Parenchyma? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3053-3064. [PMID: 31037753 DOI: 10.1002/jum.15013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES This study aimed to compare 2 types of strain ratios (SRs) in thyroid nodules. Two reference points were used: the sternocleidomastoid (SCM) muscle and the thyroid parenchyma. METHODS A total of 101 nodules in 83 patients were prospectively enrolled in the study. For the semiquantitative analysis, 2 types of SRs were used: SR1, the ratio of the SCM muscle strain to the thyroid nodule strain; and SR2, the ratio of the surrounding normal thyroid tissue strain to the thyroid nodule strain. For each nodule, the SR1 and SR2 elastographic values were calculated, and their averages were compared. RESULTS Eighty-one (80.2%) of 101 thyroid nodules were benign, and 20 (19.8%) were malignant. In both benign and malignant histopathologic types, the SR1 averages were significantly higher than the SR2 averages (P = .001; P < .001, respectively). Both the SR1 and SR2 values were found to be significantly successful in differentiating benign from malignant histopathologic types (P < .001 for both). The areas under the curve were then compared for the methods, and the difference was found to be statistically significant (P = .046). The diagnostic accuracy of the SR1 was superior to that of the SR2. CONCLUSIONS The SR1 and SR2 are effective adjunctive diagnostic tools for identifying malignant thyroid nodules. Using the SCM muscle as a reference point instead of thyroid tissue may be a more valuable way to measure SRs.
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Affiliation(s)
- Feride Fatma Görgülü
- Department of Radiology, University of Health Sciences, Adana City Research and Training Hospital Otorhinolaryngology Department, Adana, Turkey
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Marturano I, Russo M, Malandrino P, Buscema M, La Rosa GL, Spadaro A, Manzella L, Sciacca L, L'abbate L, Rizzo L. Combined use of sonographic and elastosonographic parameters can improve the diagnostic accuracy in thyroid nodules at risk of malignancy at cytological examination. MINERVA ENDOCRINOL 2019; 45:3-11. [PMID: 31625708 DOI: 10.23736/s0391-1977.19.02945-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Thyroid nodules diagnosed as Thy3B at fine-needle aspiration biopsy have a relevant risk of malignancy (15-30%) and are usually addressed to surgery. However surgery will result unnecessary in most cases. The present study aims at evaluating the possible increase of diagnostic accuracy for predicting malignancy using novel sonographic and elastographic parameters. METHODS In fifty patients undergoing thyroidectomy because of a Thy3B thyroid nodule, sonographic and elastosonographic evaluation was carried out by single operator before surgery. Five sonographic parameters (echogenicity, irregular margins, microcalcifications, intra-nodule blood flow and its irregularity) and two elastosonographic parameters (intra-nodule stiffness and its extension to adjacent tissue) were considered. After obtaining histological diagnosis, diagnostic accuracy was calculated. RESULTS When the two procedures were analyzed separately, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were 100%, 85%, 63% and 100% for ultrasonography and 60%, 92.5%, 67%, 90% for elastrosonography, respectively. The newly introduced evaluation procedures increased sensitivity. When a combined sonographic and elastosonographic evaluation was introduced, diagnostic accuracy was significantly improved: when ≥4 out of the seven parameters indicated were present, the risk of malignancy was very high (sensitivity 100%, specificity 92.55%, PPV 77%, NPV 100%). CONCLUSIONS A novel combined sonographic and elastosonographic parameter evaluation improved diagnostic accuracy for identifying thyroid nodules suspicious of malignancy.
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Affiliation(s)
- Ilenia Marturano
- Department of Experimental and Clinical Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - Marco Russo
- Department of Experimental and Clinical Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy -
| | - Pasqualino Malandrino
- Department of Experimental and Clinical Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - Massimo Buscema
- Center of Diabetology and Endocrine Diseases, Cannizzaro Hospital, Catania, Italy
| | - Giacomo L La Rosa
- Department of Experimental and Clinical Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - Angela Spadaro
- Department of Experimental and Clinical Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - Livia Manzella
- Center of Experimental Oncology and Hematology, Department of Experimental and Clinical Medicine, Catania University Hospital, Catania, Italy
| | - Laura Sciacca
- Department of Experimental and Clinical Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - Luca L'abbate
- Department of Economics, Business and Statistics, University of Palermo, Palermo, Italy
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Dobruch-Sobczak K, Migda B, Krauze A, Mlosek K, Słapa RZ, Wareluk P, Bakuła-Zalewska E, Adamczewski Z, Lewiński A, Jakubowski W, Dedecjus M. Prospective analysis of inter-observer and intra-observer variability in multi ultrasound descriptor assessment of thyroid nodules. J Ultrason 2019; 19:198-206. [PMID: 31807325 PMCID: PMC6856778 DOI: 10.15557/jou.2019.0030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/29/2019] [Indexed: 12/31/2022] Open
Abstract
Aim: The aim of this study was to evaluate the inter- and intra-observer variability and accuracy of ultrasound assessment of thyroid nodules using a descriptive lexicon. Materials and methods: A prospective study was performed on complete ultrasound examinations, including sonoelastography and color Doppler ultrasound of 18 patients with 20 thyroid nodules. A total of 20 records of thyroid nodules from these techniques were duplicated, numbered, and randomly arranged. Five radiologists assessed the recordings independently. Cohen Kappa and Fleiss Kappa statistics were used to determine the degree of intra- and inter-observer agreement. Results: Mean accuracy rates for all radiologists, for all ultrasound features, ranged from 82.7 to 87.8%. For B-mode and strain elastography, accuracies ranged from 65.0 to 100% and 47.4 to 86.8%, respectively. Concerning intra-observer variability, three radiologists demonstrated almost perfect agreement (the κ-value ranged from 0.81 to 0.86), and a substantial agreement was noted for the two remaining radiologists. The κ-values for inter-observer agreement ranged from 0.61 for macrocalcifications (substantial agreement) to 0.33 for Asteria four-point elastography scale criteria (fair agreement). Conclusions: The results suggest relatively good inter-observer and excellent intra-observer agreement in the assessment of thyroid nodules using ultrasound, and fair agreement in the case of strain elastography.
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Affiliation(s)
- Katarzyna Dobruch-Sobczak
- Department of Radiology II, The Maria Skłodowska Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.,Department of Ultrasound, Institute of Fundamental Technological Research, PAS, Warsaw, Poland
| | - Bartosz Migda
- Diagnostic Imaging Department, Medical University of Warsaw, 2nd Faculty of Medicine with the English Division and the Physiotherapy Division, Warsaw, Poland
| | - Agnieszka Krauze
- Diagnostic Imaging Department, Medical University of Warsaw, 2nd Faculty of Medicine with the English Division and the Physiotherapy Division, Warsaw, Poland
| | - Krzysztof Mlosek
- Diagnostic Imaging Department, Medical University of Warsaw, 2nd Faculty of Medicine with the English Division and the Physiotherapy Division, Warsaw, Poland
| | - Rafał Z Słapa
- Diagnostic Imaging Department, Medical University of Warsaw, 2nd Faculty of Medicine with the English Division and the Physiotherapy Division, Warsaw, Poland
| | - Paweł Wareluk
- Diagnostic Imaging Department, Medical University of Warsaw, 2nd Faculty of Medicine with the English Division and the Physiotherapy Division, Warsaw, Poland
| | - Elwira Bakuła-Zalewska
- Department of Pathology The Maria Skłodowska Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Zbigniew Adamczewski
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Poland.,Polish Mother's Memorial Hospital-Research Institute, Poland
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Poland.,Polish Mother's Memorial Hospital-Research Institute, Poland
| | - Wiesław Jakubowski
- Diagnostic Imaging Department, Medical University of Warsaw, 2nd Faculty of Medicine with the English Division and the Physiotherapy Division, Warsaw, Poland
| | - Marek Dedecjus
- Department of Nuclear Medicine and Endocrine Oncology, The Maria Skłodowska Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
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Strain Elastography as a Valuable Diagnosis Tool in Intermediate Cytology (Bethesda III) Thyroid Nodules. Diagnostics (Basel) 2019; 9:diagnostics9030119. [PMID: 31540296 PMCID: PMC6787586 DOI: 10.3390/diagnostics9030119] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 01/21/2023] Open
Abstract
Fine needle aspiration (FNA) is considered the gold standard in the diagnostic of thyroid nodules. Using the recommended BETHESDA reporting system, up to 20% of results are classified as intermediate cytology. As there is no consensus whether ultrasound evaluation, lobectomy or surgery is the best treatment option, intermediate cytology results are considered a grey zone of the FNA. The main aim of our study was to evaluate the performance of combined advanced ultrasound techniques in the process of diagnosis and evaluation of the intermediate cytology cases after FNA. We evaluated 54 consecutive cases with intermediate cytology on FNA, using conventional B-mode ultrasound (2B), and strain elastography, using a linear multifrequency 6-13 MHz linear probe (Hitachi Prerius Machine, Hitachi Inc, Japan). All nodules were classified with our Thyroid Imaging Report and Data System (TI-RADS) proposed model, considering: vertical appearance, with antero-posterior diameter bigger than the transvers diameter, the so called taller than wide shape, irregular borders, intranodular inhomogeneity, marked hypoecogenicity, micro calcifications, the presence of suspect lymph nodes, and increased stiffness as suspicious for malignancy. The classification outcomes were compared with the pathology results, considered the gold standard diagnosis. The prevalence of cancer was 28.8%, with 13/45 cases having a clear diagnostic of cancer. Six cases were diagnosed with borderline follicular neoplasia, a category with unclear evolution, also considered as malignant in the analysis of the imaging results. In total, 16/19 cancer cases had increased stiffness on elastography. The cancer prevalence increased with TI-RADS category, being 25% in TI-RADS 4b category and 92.8% in TI-RADS 5 category. The AUROC (Area Under Receiver Operating Curve) of elastography alone, in differentiation of malignant thyroid nodules was 74.9%; the combination of elastographic and conventional ultrasound characteristics generated an even better AUROC, of 84.5%. The combined conventional ultrasound and elastography identified thyroid cancer in cases with intermediate cytology with a sensitivity of 89.5% with a specificity of 50%. High risk thyroid nodules, identified by combined high risk conventional ultrasound characteristics and increased stiffness, on strain elastography, are highly predictive for malignancy, in the intermediate cytology cases.
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Moraes PHDM, Sigrist R, Takahashi MS, Schelini M, Chammas MC. Ultrasound elastography in the evaluation of thyroid nodules: evolution of a promising diagnostic tool for predicting the risk of malignancy. Radiol Bras 2019; 52:247-253. [PMID: 31435087 PMCID: PMC6696751 DOI: 10.1590/0100-3984.2018.0084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The elastic properties of tissue have always been of interest in clinical practice. In the past, the identification of structures that were stiffer on physical palpation would raise the suspicion that "there was something wrong". With the development and advancement of medicine, there proved to be a true correlation in the prediction of malignancy of a lesion: malignant disease tends to stiffen the affected tissue, either by increased cell proliferation or fibrosis. Palpation is the oldest method for the detection of thyroid nodules, which is informed by the knowledge that malignant thyroid lesions tend to be much harder than benign ones. Unfortunately, palpation is a highly subjective method that is dependent on the size and location of the lesion, as well as on the skill of the physician. In cases where these nodules are very small or are located in deep regions, their detection by palpation is difficult or even impossible. In addition, although a malignant lesion differs in terms of elasticity, it may not have echogenic properties, preventing its detection by conventional ultrasound. Imaging that indicates the stiffness or deformation of tissues, through the use of ultrasound elastography techniques, adds new information related to their structural formation. In this article, we review the basic physical principles of elastography and the evolution of the method for the evaluation of thyroid nodules, as well as the limitations of and future perspectives for its use.
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Affiliation(s)
- Pedro Henrique de Marqui Moraes
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Rosa Sigrist
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Marcelo Straus Takahashi
- Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr/HC-FMUSP), São Paulo, SP, Brazil
| | - Marcelo Schelini
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Maria Cristina Chammas
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
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Diagnostic value of multimodal ultrasound imaging in differentiating benign and malignant TI-RADS category 4 nodules. Int J Clin Oncol 2019; 24:632-639. [PMID: 30825007 PMCID: PMC6525125 DOI: 10.1007/s10147-019-01397-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/09/2019] [Indexed: 12/18/2022]
Abstract
Background Differential diagnosis of benign and malignant thyroid imaging reporting and data system category 4 (TI-RADS-4) nodules can be difficult using conventional ultrasound (US). This study aimed to evaluate whether multimodal ultrasound imaging can improve differentiation and characterization of benign and malignant TI-RADS-4 nodules. Methods Multimodal ultrasound imaging, including US, superb microvascular imaging (SMI), and real-time elastography (RTE), were performed on 196 TI-RADS-4 nodules (78, benign; 118, malignant) in 170 consecutive patients. The sensitivity, specificity, accuracy, false negative rate (FNR), and false positive rate (FPR) of each single method and that of multimodal US imaging were determined by comparison with surgical pathology results. Results The sensitivity, specificity, accuracy, FNR, and FPR for US were 65.25%, 69.23%, 66.84%, 34.75%, 30.77%, respectively; for SMI were 77.97%, 93.59%, 84.18%, 22.03%, 6.41%, respectively; RTE, 80.51%, 84.62%, 82.14%, 19.49%, 15.38%; and for multimodal US imaging were 94.08%, 87.18%, 91.33%, 6.93%, 12.82%, respectively. The areas under the received operating characteristic curve for US, SMI, RTE, and multimodal US imaging in evaluating benign and malignant TI-RADS-4 nodules were 67.2%, 84.40%, 86.60%, and 95.50%, respectively. Conclusions The initial clinical results suggest that multimodal US imaging improves the diagnostic accuracy of TI-RADS-4 nodules and provides additional information for differentiating malignant and benign nodules.
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Sengul D, Sengul I, Van Slycke S. Risk stratification of the thyroid nodule with Bethesda indeterminate cytology, category III, IV, V on the one surgeon-performed US-guided fine-needle aspiration with 27-gauge needle, verified by histopathology of thyroidectomy: the additional value of one surgeon-performed elastography. Acta Chir Belg 2019; 119:38-46. [PMID: 30606092 DOI: 10.1080/00015458.2018.1551769] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim is to assess the value of strain elastography (SE) in differentiating likelihood of malignancy for the thyroid nodules, possessing the Bethesda Category III, IV, and V indeterminate cytology. METHODS The data was obtained by ultrasonography (US)-guided fine-needle aspiration (US-g-FNA) via 27-gauge needle, with the verification of indicated thyroidectomies in a retrospective analysis, from April 2010 to April 2014, by enrolling the documents of 262 consecutive patients, with 327 thyroid nodules, subjected to one-surgeon performed neck US, SE, and US-g-FNA with 27-G needle to rule out the malignancy. RESULTS 122 of 327 cases were Bethesda Category III, IV, and V with histopathologically benign, 110 (90.2%); PTC, 7 (5.7%); FTC, 4 (3.3%); HCC, 1 (0.8%). Tsukuba Elasticity Score (TES) 1, 2, 3, 4, and 5 were detected as 38 (31.1%), 8 (6.6%), 59 (48.4%), 4 (3.3%), and 13 (10.7%), respectively for the cases with the indeterminate cytology. No significant difference was detected between TES 4 and 5 and malign histopathology by McNemar test (p = .727) with a good level of concordance, the kappa coefficient, 0.737. CONCLUSION SE may be a useful tool in differentiating malign from benign thyroid nodules by selecting surgery adaptation even for Bethesda indeterminate cytology on FNAC.
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Affiliation(s)
- Demet Sengul
- Department of Pathology, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Ilker Sengul
- Division of Endocrine Surgery, Giresun University Faculty of Medicine, Giresun, Turkey
- Department of General Surgery, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, OLV Ziekenhuis Aalst, Aalst, Belgium
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Demet S, Ilker S. Effect of anatomo-topographic and sonographic Polarity of the thyroid nodules on the thyroid malignancy by evaluating its impression on the relationship between the Bethesda System, TBSRTC, Strain Elastography Score and the thyroid histopathology. SANAMED 2019. [DOI: 10.24125/sanamed.v14i1.325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: The goal is to evaluate the association between the topo-sonographic polarity of the thyroid nodules and the thyroid malignancy by analyzing its effect on The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), score of Strain Elastography (SE) for thyroid as Tsukuba Elasticity Score (TES), and histopathologic assessment. Material and Methods: A preliminary single-center retrospective study was carried out by including the documents of 641 consecutive eligible patients, possessing 770 thyroid nodules which undergone neck ultrasonography (US), Doppler US, SE, and US-guided-fine needle aspiration (FNA) during April 2011 to April 2017. The stiffness had been measured by TES of SE. The ability of the prediction of the malignancy by the polarity of 770 thyroid nodules considering the association between; i) TBSRTC and histopathology and ii) TES and histopathology had been evaluated. Results: Of the 770 thyroid nodules evaluated, 408 (53.0%) were located at the superior pole (Pol 1) while 362 (47.0%) were at the inferior pole (Pol 0) with 0.9046 AUC and 0.8171 AUC for the association between TBSRTC and histopathology and 0.9280 AUC and 0.7888 AUC for the association between TES and histopathology, respectively. However, those difference were not significant for Pol 1, topographically. Conclusion: The topograghic and sonographic polarity of the thyroid nodules may not be useful for estimating the thyroid malignancy by using the association between TBSRTC and histopathology with TES and histopathology. However, the association with Pol 1, the superior thyroid pole, was stronger though the difference was not significant.
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Accuracy of the European Thyroid Imaging Reporting and Data System (EU-TIRADS) in the valuation of thyroid nodule malignancy in reference to the post-surgery histological results. Pol J Radiol 2018; 83:e579-e586. [PMID: 30800196 PMCID: PMC6384399 DOI: 10.5114/pjr.2018.81556] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/29/2018] [Indexed: 01/10/2023] Open
Abstract
Purpose To assess the clinical usefulness of the European Thyroid Imaging and Reporting Data System (EU-TIRADS) in the valuation of thyroid nodules malignancy in reference to post-surgery histological results. Material and methods Pre-operative ultrasound was performed in consecutive patients admitted for thyroid surgery between June 2017 and January 2018. Thyroid nodules were classified according to EU-TIRADS to five groups: 1-5. At least one fine-needle aspiration biopsy (FNAB)/patient (dominant or suspected nodule) was performed in an outpatient clinic. The final diagnosis was based on the histological result. The percentage of cancers in each EU-TIRADS group was evaluated. Finally, sensitivity, specificity, accuracy, as well as positive and negative predictive values for malignancy were assessed. Results Fifty-two patients with a total of 140 thyroid nodules (median: 3 nodules/thyroid [minimum-maximum: 1-6]) were enrolled in the study. Thyroid cancer was diagnosed in 0% (0/6) in EU-TIRADS 2; 0% (0/92) in EU-TIRADS 3; 5.9% (2/34) in EU-TIRADS 4, and 75% (6/8) in EU-TIRADS 5. In nodules assessed as EU-TIRADS ≥ 4 sensitivity, specificity, positive and negative predictive values for malignancy were, respectively: 75% (CI 95%: 40.7-93.5), 94.1% (CI 95%: 86.0-98.5), 75% (CI 95%: 40.7-93.5), and 94.1% (CI 95%: 86.0-98.5). Conclusions EU-TIRADS is a valuable and simple tool for assessment of the risk of malignancy of thyroid nodules and demonstrates a high ultrasound correlation with histological post-surgery results. FNAB should be performed in all nodules assessed as EU-TIRADS ≥ 4, due to higher risk of malignancy.
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Tavare AN, Alfuraih AM, Hensor EMA, Astrinakis E, Gupta H, Robinson P. Shear-Wave Elastography of Benign versus Malignant Musculoskeletal Soft-Tissue Masses: Comparison with Conventional US and MRI. Radiology 2018; 290:410-417. [PMID: 30480491 DOI: 10.1148/radiol.2018180950] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose To examine if shear-wave elastography (SWE) improves the accuracy of diagnosing soft-tissue masses as benign or malignant compared with US alone or in combination with MRI. Materials and Methods Two hundred six consecutive adult participants (mean age, 57.7 years; range, 18-91 years), including 89 men (median age, 56.0 years; range, 21-91 years) and 117 women (median age, 59.1 years; range, 18-88 years), who were referred for biopsy of a soft-tissue mass were prospectively recruited from December 2015 through March 2017. Participants underwent B-mode US, MRI, and SWE prior to biopsy. Three musculoskeletal radiologists independently reviewed US images alone, followed by US and MRI images together, and classified lesions as benign, probably benign, probably malignant, or malignant. For SWE, the area under the receiver operating characteristic (ROC) curve (AUC) was calculated for transverse shear-wave velocity (SWV). Multivariable logistic regression was used to investigate the association between SWE and malignancy alongside individual demographic and imaging variables. Results At histologic examination, 79 of 206 (38%) participants had malignant lesions. SWV showed good diagnostic accuracy for lesions classified as benign or probably benign by US alone (AUC = 0.87 [95% confidence interval {CI}: 0.79, 0.95]). SWV did not provide substantive diagnostic information for lesions classified as probably malignant or malignant, whether the classification was made with or without MRI. However, multivariable modeling indicated that diagnostic accuracy may vary by lesion position (interaction P = .02; superficial, odds ratio [OR] = 17.7 [95% CI: 1.50, 207], P = .02; deep/mixed, OR = 0.24 [95% CI: 0.07, 0.86], P = .03) and participant age (interaction P = .01; eg, age 43 years, OR = 0.72 [95% CI: 0.15, 3.5], P = .69; age 72 years, OR = 0.08 [95% CI: 0.02, 0.37], P = .001). Conclusion Shear-wave elastography can increase accuracy of soft-tissue lesion diagnosis in conjunction with US. However, a single cut-off may not be universally applicable with diagnostic accuracy that is affected by lesion position and patient age. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Aniket N Tavare
- From the Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds LS7 4SA, England (A.N.T., E.A., H.G., P.R.); Leeds Biomedical Research Centre, University of Leeds, Leeds, England (A.M.A., E.M.A.H., P.R.); Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj, Saudi Arabia (A.M.A.); and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, England (A.M.A., E.M.A.H.)
| | - Abdulrahman M Alfuraih
- From the Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds LS7 4SA, England (A.N.T., E.A., H.G., P.R.); Leeds Biomedical Research Centre, University of Leeds, Leeds, England (A.M.A., E.M.A.H., P.R.); Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj, Saudi Arabia (A.M.A.); and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, England (A.M.A., E.M.A.H.)
| | - Elizabeth M A Hensor
- From the Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds LS7 4SA, England (A.N.T., E.A., H.G., P.R.); Leeds Biomedical Research Centre, University of Leeds, Leeds, England (A.M.A., E.M.A.H., P.R.); Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj, Saudi Arabia (A.M.A.); and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, England (A.M.A., E.M.A.H.)
| | - Emmanouil Astrinakis
- From the Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds LS7 4SA, England (A.N.T., E.A., H.G., P.R.); Leeds Biomedical Research Centre, University of Leeds, Leeds, England (A.M.A., E.M.A.H., P.R.); Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj, Saudi Arabia (A.M.A.); and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, England (A.M.A., E.M.A.H.)
| | - Harun Gupta
- From the Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds LS7 4SA, England (A.N.T., E.A., H.G., P.R.); Leeds Biomedical Research Centre, University of Leeds, Leeds, England (A.M.A., E.M.A.H., P.R.); Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj, Saudi Arabia (A.M.A.); and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, England (A.M.A., E.M.A.H.)
| | - Philip Robinson
- From the Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds LS7 4SA, England (A.N.T., E.A., H.G., P.R.); Leeds Biomedical Research Centre, University of Leeds, Leeds, England (A.M.A., E.M.A.H., P.R.); Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj, Saudi Arabia (A.M.A.); and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, England (A.M.A., E.M.A.H.)
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Chen YF, Mao XW, Zhang YJ, Zhang CY, Yu YF, Qin E, Chen X, Shen JX. Endobronchial Ultrasound Elastography Differentiates Intrathoracic Lymph Nodes: A Meta-Analysis. Ann Thorac Surg 2018; 106:1251-1257. [DOI: 10.1016/j.athoracsur.2018.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 12/27/2022]
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Zhao CK, Xu HX. Ultrasound elastography of the thyroid: principles and current status. Ultrasonography 2018; 38:106-124. [PMID: 30690960 PMCID: PMC6443591 DOI: 10.14366/usg.18037] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/01/2018] [Indexed: 12/31/2022] Open
Abstract
Ultrasound (US) elastography has been introduced as a non-invasive technique for evaluating thyroid diseases. This paper presents a detailed description of the technical principles, peculiarities, and limitations of US elastography techniques, including strain elastography and shear-wave elastography. This review was conducted from a clinical perspective, and aimed to assess the usefulness of US elastography for thyroid diseases in specific clinical scenarios. Although its main focus is on thyroid nodules, the applications of US elastography for other thyroid diseases, such as diffuse thyroid diseases and thyroiditis, are also presented. Furthermore, unresolved questions and directions for future research are also discussed.
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Affiliation(s)
- Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
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